Provider Demographics
NPI:1235466160
Name:ALVARENGA, ALEX EDGARDO (ADMIN ASSIST)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:EDGARDO
Last Name:ALVARENGA
Suffix:
Gender:M
Credentials:ADMIN ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 MISSION ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2911
Mailing Address - Country:US
Mailing Address - Phone:415-597-8055
Mailing Address - Fax:415-597-8004
Practice Address - Street 1:982 MISSION ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2911
Practice Address - Country:US
Practice Address - Phone:415-597-8055
Practice Address - Fax:415-597-8004
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker