Healthcare Provider Details

I. General information

NPI: 1821541897
Provider Name (Legal Business Name): EVERARDO ALVIZO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 03/27/2021
Certification Date: 03/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GRAND AVE # 115
LONG BEACH CA
90815-1765
US

IV. Provider business mailing address

2525 GRAND AVE # 115
LONG BEACH CA
90815-1765
US

V. Phone/Fax

Practice location:
  • Phone: 562-570-4435
  • Fax: 562-570-4106
Mailing address:
  • Phone: 562-570-4435
  • Fax: 562-570-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: