Healthcare Provider Details

I. General information

NPI: 1194603761
Provider Name (Legal Business Name): GERARDO ANTONIO ALVARADO RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E SLAUSON AVE STE B
HUNTINGTON PARK CA
90255-2725
US

IV. Provider business mailing address

2764 SOUTHERN AVE APT A
SOUTH GATE CA
90280-3179
US

V. Phone/Fax

Practice location:
  • Phone: 323-277-7678
  • Fax:
Mailing address:
  • Phone: 323-610-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: