Healthcare Provider Details

I. General information

NPI: 1790248276
Provider Name (Legal Business Name): RODOLFO ALVARADO PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18107 SHERMAN WAY STE 200
RESEDA CA
91335-8802
US

IV. Provider business mailing address

8119 MCNULTY AVE
WINNETKA CA
91306-1733
US

V. Phone/Fax

Practice location:
  • Phone: 818-783-1002
  • Fax:
Mailing address:
  • Phone: 818-456-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: