Healthcare Provider Details

I. General information

NPI: 1811835259
Provider Name (Legal Business Name): ALEXIS CHRISTINA TAVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S ARROYO PKWY STE 100
PASADENA CA
91105-3973
US

IV. Provider business mailing address

1020 S ARROYO PKWY STE 100
PASADENA CA
91105-3973
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-2794
  • Fax:
Mailing address:
  • Phone: 626-403-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: