Healthcare Provider Details

I. General information

NPI: 1750804894
Provider Name (Legal Business Name): OPHELIA ALVAREZ LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2457 ENDICOTT ST
LOS ANGELES CA
90032-3047
US

IV. Provider business mailing address

2457 ENDICOTT ST
LOS ANGELES CA
90032-3047
US

V. Phone/Fax

Practice location:
  • Phone: 323-227-5252
  • Fax:
Mailing address:
  • Phone: 323-227-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN144220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: