Healthcare Provider Details

I. General information

NPI: 1699971952
Provider Name (Legal Business Name): JOHN PETER ALVARADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MODESTO AVE
MODESTO CA
95354-0414
US

IV. Provider business mailing address

1917 MEMORIAL DRIVE
CERES CA
95307
US

V. Phone/Fax

Practice location:
  • Phone: 209-527-4597
  • Fax: 209-527-4599
Mailing address:
  • Phone: 209-281-6179
  • Fax: 209-541-2556

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 TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberASW74656
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: