Healthcare Provider Details

I. General information

NPI: 1306795711
Provider Name (Legal Business Name): ROGELIO ALVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

762 GRISWOLD AVE
SAN FERNANDO CA
91340-2105
US

IV. Provider business mailing address

18937 NORDHOFF ST
NORTHRIDGE CA
91324-3710
US

V. Phone/Fax

Practice location:
  • Phone: 747-500-9405
  • Fax:
Mailing address:
  • Phone: 818-274-9761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: