Healthcare Provider Details

I. General information

NPI: 1215548359
Provider Name (Legal Business Name): OCTAVIO ALVAREZ HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 1ST ST
EUREKA CA
95501-0840
US

IV. Provider business mailing address

2107 1ST ST
EUREKA CA
95501-0840
US

V. Phone/Fax

Practice location:
  • Phone: 707-273-6395
  • Fax: 707-442-2058
Mailing address:
  • Phone: 707-273-6395
  • Fax: 707-442-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: