=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194603761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERARDO ANTONIO ALVARADO RDN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2025
-----------------------------------------------------
Last Update Date | 08/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 E SLAUSON AVE STE B
-----------------------------------------------------
City | HUNTINGTON PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90255-2725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-277-7678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2764 SOUTHERN AVE APT A
-----------------------------------------------------
City | SOUTH GATE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90280-3179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-610-4574
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133VN1101X
-----------------------------------------------------
Taxonomy Name | Gerontological Nutrition Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------