Healthcare Provider Details

I. General information

NPI: 1154739837
Provider Name (Legal Business Name): ENRIQUETA ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2014
Last Update Date: 07/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 COFFEE RD STE D
MODESTO CA
95355-4241
US

IV. Provider business mailing address

836 LA SOMBRA AVE
MODESTO CA
95354-1434
US

V. Phone/Fax

Practice location:
  • Phone: 209-527-6100
  • Fax:
Mailing address:
  • Phone: 209-735-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: