MEDICARE: DR. JESSICA ISABEL ALVA PHD

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	103G00000X	Clinical Neuropsychologist	0810006069	VA

General Provider Information

NPI Number	:	1518434604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA ISABEL ALVA PHD

Provider Business Mailing Address
First Line	:	1201 BROAD ROCK BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23249-0001
Country	:	US
Telephone Number	:	804-675-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 BROAD ROCK BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23249-5038
Country	:	US
Telephone Number	:	804-675-5000
Fax Number	:

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

Provider Enumeration Date	:	10/27/2018
Last Update Date	:	03/15/2022

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