Provider Demographics
NPI:1164549002
Name:ALVAREZ, RUBEN EDWARD
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:EDWARD
Last Name:ALVAREZ
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 1:1155 TANNEHILL DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7944
Mailing Address - Country:US
Mailing Address - Phone:209-824-0122
Mailing Address - Fax:
Practice Address - Street 1:1155 TANNEHILL DR
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7944
Practice Address - Country:US
Practice Address - Phone:209-824-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)