Healthcare Provider Details

I. General information

NPI: 1679283840
Provider Name (Legal Business Name): ALFONSO ALVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N MARKET ST STE 300
SAN JOSE CA
95113-1211
US

IV. Provider business mailing address

2 N MARKET ST STE 300
SAN JOSE CA
95113-1211
US

V. Phone/Fax

Practice location:
  • Phone: 510-210-3233
  • Fax: 510-373-2487
Mailing address:
  • Phone: 510-210-3233
  • Fax: 510-373-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: