Healthcare Provider Details

I. General information

NPI: 1447938519
Provider Name (Legal Business Name): DESTINEE ANISSA ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 IMPERIAL HWY
DOWNEY CA
90242-3464
US

IV. Provider business mailing address

7860 IMPERIAL HWY
DOWNEY CA
90242-3464
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-8525
  • Fax:
Mailing address:
  • Phone: 562-869-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number89251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: