Healthcare Provider Details

I. General information

NPI: 1609577907
Provider Name (Legal Business Name): ALVARADO FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 KEARNY VILLA ROAD #118
SAN DIEGO CA
92123
US

IV. Provider business mailing address

2127 OLYMPIC PKWY SUITE 1006 #353
CHULA VISTA CA
91915
US

V. Phone/Fax

Practice location:
  • Phone: 619-928-4843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JEANA ABADEJOS
Title or Position: OWNER
Credential:
Phone: 619-928-4843