Healthcare Provider Details

I. General information

NPI: 1801038294
Provider Name (Legal Business Name): ROSALINDA ALVARADO-GOMEZ NURSE PRACTIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 N MISSION RD TRLR 11
LOS ANGELES CA
90033-1019
US

IV. Provider business mailing address

1240 N MISSION RD TRLR 11
LOS ANGELES CA
90033-1019
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-2216
  • Fax:
Mailing address:
  • Phone: 323-226-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN 264280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: