Healthcare Provider Details

I. General information

NPI: 1417445537
Provider Name (Legal Business Name): KIMBERLY JANET ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 10/15/2024
Certification Date: 02/03/2023
Deactivation Date: 04/23/2020
Reactivation Date: 06/25/2020

III. Provider practice location address

3924 RIVERVIEW DR
RIVERSIDE CA
92509-6611
US

IV. Provider business mailing address

1957 S RESERVOIR ST APT B
POMONA CA
91766-5550
US

V. Phone/Fax

Practice location:
  • Phone: 951-416-1572
  • Fax: 951-394-7426
Mailing address:
  • Phone: 909-529-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111172
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number87690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: