Provider Demographics
NPI:1508201856
Name:ALVAREZ, LUPITA NOEMI (PA)
Entity Type:Individual
Prefix:MS
First Name:LUPITA
Middle Name:NOEMI
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:GUADALUPE
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-1929
Mailing Address - Country:US
Mailing Address - Phone:530-304-8107
Mailing Address - Fax:
Practice Address - Street 1:1910 N PARK ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-1929
Practice Address - Country:US
Practice Address - Phone:530-304-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22930363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant