Healthcare Provider Details

I. General information

NPI: 1285281576
Provider Name (Legal Business Name): MELISSA JARA ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 INDUSTRY WAY
LYNWOOD CA
90262-4024
US

IV. Provider business mailing address

2620 INDUSTRY WAY
LYNWOOD CA
90262-4024
US

V. Phone/Fax

Practice location:
  • Phone: 323-242-5000
  • Fax:
Mailing address:
  • Phone: 323-242-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number91311
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: