Provider Demographics
NPI:1154078095
Name:ALVAREZ, STEPHANIE GUADALUPE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GUADALUPE
Last Name:ALVAREZ
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 1:947 S ANAHEIM BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5583
Mailing Address - Country:US
Mailing Address - Phone:714-533-2157
Mailing Address - Fax:
Practice Address - Street 1:11833 167TH ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-1818
Practice Address - Country:US
Practice Address - Phone:562-281-2713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH162610183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician