Healthcare Provider Details

I. General information

NPI: 1962939843
Provider Name (Legal Business Name): STEFAN ALVIDREZ MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7313 N DE WOLF AVE
CLOVIS CA
93619-9239
US

IV. Provider business mailing address

7313 N DE WOLF AVE.
CLOVIS CA
93619
US

V. Phone/Fax

Practice location:
  • Phone: 253-736-4391
  • Fax:
Mailing address:
  • Phone: 253-736-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: