Healthcare Provider Details

I. General information

NPI: 1962567479
Provider Name (Legal Business Name): JOEL ROSANO-ALVAREZ M.A., C.A.D.C.1,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W HAYES ST
WOODBURN OR
97071-4616
US

IV. Provider business mailing address

PO BOX 50
MOUNT ANGEL OR
97362-0050
US

V. Phone/Fax

Practice location:
  • Phone: 503-566-2901
  • Fax: 503-566-2977
Mailing address:
  • Phone: 503-566-2901
  • Fax: 503-566-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIN PROCESS
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01-P-09
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: