Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95013839 | CA |
NPI | 1003444597 |
---|---|
Provider Name | Starly Alvarado |
First Address | Newport Beach, CA 92660-8105 |
Second Address | Newport Beach, CA 92660-8105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2020 |
Last Update Date | 30/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
95013839 | BOARD OF REGISTERED NURSING (01) | CA |