Healthcare Provider Details

I. General information

NPI: 1033895925
Provider Name (Legal Business Name): JEANETTE ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 58TH AVE
OAKLAND CA
94621
US

IV. Provider business mailing address

26081 MOCINE AVE
HAYWARD CA
94544-2923
US

V. Phone/Fax

Practice location:
  • Phone: 510-305-0081
  • Fax:
Mailing address:
  • Phone: 510-881-5921
  • Fax: 510-881-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150159
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: