Provider Demographics
NPI:1225726391
Name:ALVARADO, JAMES GILBERT (RD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GILBERT
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:JIMMY
Other - Middle Name:GILBERT
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:TWIN PEAKS
Mailing Address - State:CA
Mailing Address - Zip Code:92391-0871
Mailing Address - Country:US
Mailing Address - Phone:210-392-1190
Mailing Address - Fax:
Practice Address - Street 1:490 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:TWIN PEAKS
Practice Address - State:CA
Practice Address - Zip Code:92391-0779
Practice Address - Country:US
Practice Address - Phone:210-392-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86049718133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered