Provider Demographics
NPI:1407223167
Name:ALVAREZ, JESSICA DENISSE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DENISSE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 NELSON ST
Mailing Address - Street 2:APT. C
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-5958
Mailing Address - Country:US
Mailing Address - Phone:909-242-0612
Mailing Address - Fax:
Practice Address - Street 1:10155 COLIMA RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2042
Practice Address - Country:US
Practice Address - Phone:562-692-0383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program