Provider Demographics
NPI:1114104205
Name:ALVARADO, LOURDES (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LOURDES
Other - Middle Name:
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1666 MEDICAL CENTER DR STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1257
Mailing Address - Country:US
Mailing Address - Phone:909-881-5007
Mailing Address - Fax:951-689-4800
Practice Address - Street 1:3814 LA SIERRA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3528
Practice Address - Country:US
Practice Address - Phone:951-729-4800
Practice Address - Fax:951-689-4800
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice