Healthcare Provider Details

I. General information

NPI: 1497125454
Provider Name (Legal Business Name): JENNIFER ALVARADO OTR/L ID #: 15472
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2015
Last Update Date: 10/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12610 RENVILLE ST
LAKEWOOD CA
90715-1924
US

IV. Provider business mailing address

12610 RENVILLE ST
LAKEWOOD CA
90715-1924
US

V. Phone/Fax

Practice location:
  • Phone: 562-405-4661
  • Fax:
Mailing address:
  • Phone: 562-405-4661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number15472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: