Provider Demographics
NPI:1154817898
Name:ALVARADO, JOHNNIE JR
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:
Last Name:ALVARADO
Suffix:JR
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 1:401 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2562
Mailing Address - Country:US
Mailing Address - Phone:541-298-2101
Mailing Address - Fax:
Practice Address - Street 1:401 E 3RD ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2562
Practice Address - Country:US
Practice Address - Phone:541-298-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator