Provider Demographics
NPI:1477170132
Name:ALVARADO, JAMIE LEEANN
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEEANN
Last Name:ALVARADO
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 1:1833 CAMELLIA DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-0727
Mailing Address - Country:US
Mailing Address - Phone:408-205-3619
Mailing Address - Fax:
Practice Address - Street 1:1833 CAMELLIA DR
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-0727
Practice Address - Country:US
Practice Address - Phone:408-205-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000000000OtherN/A