Healthcare Provider Details

I. General information

NPI: 1699114793
Provider Name (Legal Business Name): JESSE ALVARADO III PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 09/11/2021
Certification Date: 09/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8535 TOM SLICK
SAN ANTONIO TX
78229-3367
US

IV. Provider business mailing address

8535 TOM SLICK
SAN ANTONIO TX
78229-3367
US

V. Phone/Fax

Practice location:
  • Phone: 210-582-6487
  • Fax: 210-692-9021
Mailing address:
  • Phone: 210-582-6487
  • Fax: 210-692-9021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number908592
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1024051
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: