Healthcare Provider Details

I. General information

NPI: 1629624523
Provider Name (Legal Business Name): RUBY ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12730 HAWTHORNE BLVD
HAWTHORNE CA
90250-3919
US

IV. Provider business mailing address

8934 SAN GABRIEL AVE UNIT B
SOUTH GATE CA
90280-3122
US

V. Phone/Fax

Practice location:
  • Phone: 310-644-4000
  • Fax:
Mailing address:
  • Phone: 310-227-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: