Healthcare Provider Details

I. General information

NPI: 1871054841
Provider Name (Legal Business Name): CORNELIA ALCALDE RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2019
Last Update Date: 12/20/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E 6TH ST
LONG BEACH CA
90802-1402
US

IV. Provider business mailing address

4515 E PACIFIC COAST HWY STE 430
LONG BEACH CA
90804-3228
US

V. Phone/Fax

Practice location:
  • Phone: 562-241-9587
  • Fax:
Mailing address:
  • Phone: 562-447-8486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: