Healthcare Provider Details

I. General information

NPI: 1548199169
Provider Name (Legal Business Name): ANDREW MIGUEL ALVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARIN ST STE 225
THOUSAND OAKS CA
91360-4301
US

IV. Provider business mailing address

555 LAURIE LN APT N2
THOUSAND OAKS CA
91360-5537
US

V. Phone/Fax

Practice location:
  • Phone: 805-364-8521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberNONE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: