Healthcare Provider Details

I. General information

NPI: 1457810061
Provider Name (Legal Business Name): LUMINITA DOINA ALAVANZA AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 W 6TH ST STE 105
CORONA CA
92882-1644
US

IV. Provider business mailing address

1438 S MOUNTAIN VIEW AVE
SAN BERNARDINO CA
92408-3132
US

V. Phone/Fax

Practice location:
  • Phone: 888-873-6220
  • Fax: 888-873-6220
Mailing address:
  • Phone: 909-809-1663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP95011090
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95011090
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number791574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: