Provider Demographics
NPI:1417203712
Name:ALVES, MARTHA ALICIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ALICIA
Last Name:ALVES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17221 WHATLEY AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3215
Mailing Address - Country:US
Mailing Address - Phone:209-244-8770
Mailing Address - Fax:909-632-1657
Practice Address - Street 1:17221 WHATLEY AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3215
Practice Address - Country:US
Practice Address - Phone:209-244-8770
Practice Address - Fax:909-632-1657
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA644318163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management