Healthcare Provider Details

I. General information

NPI: 1912361106
Provider Name (Legal Business Name): JOHN NATHANIEL ALVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E IMPERIAL HIGHWAY
FULLERTON CA
92835
US

IV. Provider business mailing address

401 E IMPERIAL HIGHWAY
FULLERTON CA
92835
US

V. Phone/Fax

Practice location:
  • Phone: 714-447-7000
  • Fax: 714-447-7003
Mailing address:
  • Phone: 714-477-7000
  • Fax: 714-477-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA155288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: