Provider Demographics
NPI:1376249375
Name:ALVAREZ, ALIAH KAITLYN
Entity Type:Individual
Prefix:
First Name:ALIAH
Middle Name:KAITLYN
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 70332
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475-0118
Mailing Address - Country:US
Mailing Address - Phone:503-780-0292
Mailing Address - Fax:
Practice Address - Street 1:3575 SAN PABLO DAM RD STE 11
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-7205
Practice Address - Country:US
Practice Address - Phone:503-780-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty