Healthcare Provider Details

I. General information

NPI: 1659941045
Provider Name (Legal Business Name): MAYRA ALVARADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 BREA BLVD
FULLERTON CA
92835-4125
US

IV. Provider business mailing address

1370 BREA BLVD
FULLERTON CA
92835-4125
US

V. Phone/Fax

Practice location:
  • Phone: 714-732-1773
  • Fax:
Mailing address:
  • Phone: 714-732-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: