Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 15472 | CA |
NPI | 1497125454 |
---|---|
Provider Name | Jennifer Alvarado |
First Address | Lakewood, CA 90715-1924 |
Second Address | Lakewood, CA 90715-1924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2015 |
Last Update Date | 03/10/2015 |