Healthcare Provider Details

I. General information

NPI: 1033042502
Provider Name (Legal Business Name): RAFAEL ALVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44359 PALM ST
INDIO CA
92201-3116
US

IV. Provider business mailing address

45420 PARK ST APT 3
INDIO CA
92201-4363
US

V. Phone/Fax

Practice location:
  • Phone: 760-668-4479
  • Fax:
Mailing address:
  • Phone: 760-668-4479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-FUBQPJ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: