Healthcare Provider Details

I. General information

NPI: 1144943481
Provider Name (Legal Business Name): SAMUEL ROJAS ALVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. SAMUEL ROJAS ALVAREZ

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 AGNES AVE
SANTA MARIA CA
93458-2838
US

IV. Provider business mailing address

811 N RUSSELL AVE
SANTA MARIA CA
93458-2782
US

V. Phone/Fax

Practice location:
  • Phone: 805-457-3724
  • Fax: 800-417-9245
Mailing address:
  • Phone: 805-266-9532
  • Fax: 800-417-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: