Healthcare Provider Details

I. General information

NPI: 1679877690
Provider Name (Legal Business Name): JACK RAY ALVORD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CCI END OF HWY 202
TEHACHAPI CA
93561
US

IV. Provider business mailing address

1282 EL RANCHO DRIVE
TEHACHAPI CA
93561
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-4402
  • Fax:
Mailing address:
  • Phone: 661-823-7152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 15227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: