Provider Demographics
NPI:1114563632
Name:ALVARADO, JANE MIRIELLE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MIRIELLE
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 N SPURGEON ST APT D
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2470
Mailing Address - Country:US
Mailing Address - Phone:714-673-4853
Mailing Address - Fax:
Practice Address - Street 1:3303 HARBOR BLVD STE B8
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1517
Practice Address - Country:US
Practice Address - Phone:714-786-6069
Practice Address - Fax:714-834-9822
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2021-04-20
Deactivation Date:2021-03-19
Deactivation Code:
Reactivation Date:2021-04-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No175T00000XOther Service ProvidersPeer Specialist