Healthcare Provider Details

I. General information

NPI: 1700446291
Provider Name (Legal Business Name): ESDRAS ALVIZURES PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N ECKHOFF ST
ORANGE CA
92868-1008
US

IV. Provider business mailing address

800 N ECKHOFF ST
ORANGE CA
92868-1008
US

V. Phone/Fax

Practice location:
  • Phone: 714-704-6110
  • Fax:
Mailing address:
  • Phone: 714-704-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: