Healthcare Provider Details

I. General information

NPI: 1912891011
Provider Name (Legal Business Name): BLANCA ALICIA ALVARADO VILLICANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MCHENRY VILLAGE WAY STE 16
MODESTO CA
95350-4341
US

IV. Provider business mailing address

1700 MCHENRY VILLAGE WAY STE 16
MODESTO CA
95350-4341
US

V. Phone/Fax

Practice location:
  • Phone: 209-209-4440
  • Fax:
Mailing address:
  • Phone: 408-256-9521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: