Healthcare Provider Details

I. General information

NPI: 1770304727
Provider Name (Legal Business Name): JENNIFER OBANDO ALVARADO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23900 IRONWOOD AVE
MORENO VALLEY CA
92557-7151
US

IV. Provider business mailing address

17083 RED CEDAR CT
FONTANA CA
92337-6869
US

V. Phone/Fax

Practice location:
  • Phone: 951-485-2570
  • Fax:
Mailing address:
  • Phone: 909-549-1549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: