Healthcare Provider Details

I. General information

NPI: 1114484177
Provider Name (Legal Business Name): DENISE HERNANDEZ FELICE ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date: 12/02/2023
Reactivation Date: 01/16/2024

III. Provider practice location address

155 BIMINI P
LOS ANGELES CA
90004-9000
US

IV. Provider business mailing address

11046 MAIN ST
EL MONTE CA
91731-2617
US

V. Phone/Fax

Practice location:
  • Phone: 213-388-5423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberACSW119021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: