Healthcare Provider Details

I. General information

NPI: 1093436511
Provider Name (Legal Business Name): JACQUELINE ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CAPITOLA RD
SANTA CRUZ CA
95062-2912
US

IV. Provider business mailing address

501 S GREEN VALLEY RD SPC 40
WATSONVILLE CA
95076-3033
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-3500
  • Fax: 831-457-2486
Mailing address:
  • Phone: 831-254-6921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number154970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: