Provider Demographics
NPI:1417445537
Name:ALVAREZ, KIMBERLY JANET
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JANET
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 1:1957 S RESERVOIR ST APT B
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-5550
Mailing Address - Country:US
Mailing Address - Phone:909-529-3631
Mailing Address - Fax:
Practice Address - Street 1:3924 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-6611
Practice Address - Country:US
Practice Address - Phone:951-416-1572
Practice Address - Fax:951-394-7426
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2023-02-03
Deactivation Date:2020-04-23
Deactivation Code:
Reactivation Date:2020-06-25
Provider Licenses
StateLicense IDTaxonomies
CA876901041C0700X
390200000X
CA1111721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program