Provider Demographics
NPI:1275120560
Name:ALVAREZ, GRACIELA (CTRS)
Entity Type:Individual
Prefix:MS
First Name:GRACIELA
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13625 S 48TH ST APT 2045
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5061
Mailing Address - Country:US
Mailing Address - Phone:480-458-7262
Mailing Address - Fax:
Practice Address - Street 1:501 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6056
Practice Address - Country:US
Practice Address - Phone:602-244-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist