Provider Demographics
NPI:1073182440
Name:ALVARADO, BRYAN AVILES
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:AVILES
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12331 E CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3323
Mailing Address - Country:US
Mailing Address - Phone:720-507-5226
Mailing Address - Fax:720-368-5139
Practice Address - Street 1:12331 E CORNELL AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3323
Practice Address - Country:US
Practice Address - Phone:720-507-5226
Practice Address - Fax:720-368-5139
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO663907106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician