Healthcare Provider Details

I. General information

NPI: 1134745623
Provider Name (Legal Business Name): ATHENA ALVAREZ DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 CARNEGIE DR STE 125
SAN BERNARDINO CA
92408-4200
US

IV. Provider business mailing address

11374 E SERRANO SQ
YUCAIPA CA
92399-6891
US

V. Phone/Fax

Practice location:
  • Phone: 909-370-0300
  • Fax:
Mailing address:
  • Phone: 909-573-2833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: