Healthcare Provider Details

I. General information

NPI: 1265848733
Provider Name (Legal Business Name): JESSICA ALVA R.N.F.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2014
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24451 HEALTH CENTER DR
LAGUNA HILLS CA
92653-3689
US

IV. Provider business mailing address

24451 HEALTH CENTER DR
LAGUNA HILLS CA
92653-3689
US

V. Phone/Fax

Practice location:
  • Phone: 949-452-3527
  • Fax:
Mailing address:
  • Phone: 949-452-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number676000
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number676000
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number676000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: