Healthcare Provider Details

I. General information

NPI: 1457067035
Provider Name (Legal Business Name): KATHERINE MASSIEL ALVAREZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CHESTNUT AVE
LONG BEACH CA
90813-2944
US

IV. Provider business mailing address

255 W 5TH ST
SAN PEDRO CA
90731-3388
US

V. Phone/Fax

Practice location:
  • Phone: 562-753-2323
  • Fax:
Mailing address:
  • Phone: 562-805-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95251466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: