Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ||
N | 175L00000X | Homeopath |
NPI | 1225180540 |
---|---|
Provider Name | Santiago Alvarez |
First Address | Moreno Valley, CA 92553-8550 |
Second Address | Moreno Valley, CA 92553-8550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 28/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RCP 12108 | LICENSE (01) | CA |