Healthcare Provider Details

I. General information

NPI: 1194132019
Provider Name (Legal Business Name): MARLENE ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 6TH ST
CORONA CA
92882-3301
US

IV. Provider business mailing address

1076 SANTO ANTONIO DR SUITE B
COLTON CA
92324-8103
US

V. Phone/Fax

Practice location:
  • Phone: 888-682-6282
  • Fax:
Mailing address:
  • Phone: 909-433-9824
  • Fax: 909-433-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: