Healthcare Provider Details

I. General information

NPI: 1083483978
Provider Name (Legal Business Name): REINA MARCELA LINARES ALVARADO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15339 SATICOY ST
VAN NUYS CA
91406-3345
US

IV. Provider business mailing address

15339 SATICOY ST
VAN NUYS CA
91406-3345
US

V. Phone/Fax

Practice location:
  • Phone: 818-402-6736
  • Fax:
Mailing address:
  • Phone: 818-402-6736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: