Healthcare Provider Details

I. General information

NPI: 1669645776
Provider Name (Legal Business Name): PROVIDENCE M ALVIRA AU.D CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6367 ALVARADO CT STE 101
SAN DIEGO CA
92120-4904
US

IV. Provider business mailing address

12927 SLEEPY WIND ST
MOORPARK CA
93021-2935
US

V. Phone/Fax

Practice location:
  • Phone: 619-583-7002
  • Fax: 619-583-9404
Mailing address:
  • Phone: 310-989-3092
  • Fax: 805-530-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: