MEDICARE: MS. JESSICA ALVA R.N.F.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0006X	Registered Nurse First Assistant	676000	CA
2	163W00000X	Registered Nurse	676000	CA
3	163WS0121X	Plastic Surgery Registered Nurse	676000	CA

General Provider Information

NPI Number	:	1265848733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA ALVA R.N.F.A.

Provider Business Mailing Address
First Line	:	24451 HEALTH CENTER DR
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3689
Country	:	US
Telephone Number	:	949-452-3527
Fax Number	:

Provider Business Practice Location Address
First Line	:	24451 HEALTH CENTER DR
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3689
Country	:	US
Telephone Number	:	949-452-3527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2014
Last Update Date	:	07/09/2015

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