Healthcare Provider Details

I. General information

NPI: 1114298320
Provider Name (Legal Business Name): ELIZABETH MARIE ALVARADO B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 S MAIN ST STE 201
CORONA CA
92882-5303
US

IV. Provider business mailing address

4378 RIVERBEND LN
RIVERSIDE CA
92509-6604
US

V. Phone/Fax

Practice location:
  • Phone: 951-279-3222
  • Fax:
Mailing address:
  • Phone: 909-915-9743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: