Healthcare Provider Details

I. General information

NPI: 1457053944
Provider Name (Legal Business Name): TRINITY ELIZABETH ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 CA 104
IONE CA
95640
US

IV. Provider business mailing address

PO BOX 341158
SACRAMENTO CA
95834-9058
US

V. Phone/Fax

Practice location:
  • Phone: 209-274-4911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW122486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: