Healthcare Provider Details

I. General information

NPI: 1750253670
Provider Name (Legal Business Name): YESSENIA ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 10/24/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E PINE ST
LODI CA
95240-2923
US

IV. Provider business mailing address

408 E PINE ST
LODI CA
95240-2923
US

V. Phone/Fax

Practice location:
  • Phone: 209-330-7155
  • Fax:
Mailing address:
  • Phone: 209-330-7155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: