Healthcare Provider Details

I. General information

NPI: 1144024423
Provider Name (Legal Business Name): JEFFERY ALVARADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E HOSPITALITY LN STE 400
SAN BERNARDINO CA
92408-3545
US

IV. Provider business mailing address

225 E. RINCON STREET SUITE 219
CORONA CA
92879
US

V. Phone/Fax

Practice location:
  • Phone: 190-989-1159
  • Fax:
Mailing address:
  • Phone: 951-817-5328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: