Provider Demographics
NPI:1386021608
Name:ALVAREZ, MELISSA (ARDMS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E 17TH ST
Mailing Address - Street 2:STE. 210
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3231
Mailing Address - Country:US
Mailing Address - Phone:949-525-9277
Mailing Address - Fax:
Practice Address - Street 1:26118 CRESTMONT CIR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-5813
Practice Address - Country:US
Practice Address - Phone:951-500-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46-2371654293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory