Healthcare Provider Details

I. General information

NPI: 1013417203
Provider Name (Legal Business Name): JESSICA RAE MONDONEDO ALVARADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N GLENOAKS BLVD
BURBANK CA
91504-2828
US

IV. Provider business mailing address

2101 N GLENOAKS BLVD
BURBANK CA
91504-2828
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-8825
  • Fax:
Mailing address:
  • Phone: 818-848-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number92063
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00001613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: