Provider Demographics
NPI:1568764876
Name:ALVARENGA, ROCIO (OTR)
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:ALVARENGA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7806 GATEWAY BLVD E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1800
Mailing Address - Country:US
Mailing Address - Phone:915-566-7584
Mailing Address - Fax:915-566-7682
Practice Address - Street 1:4400 N MESA ST
Practice Address - Street 2:SUITE 4
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1127
Practice Address - Country:US
Practice Address - Phone:915-566-7584
Practice Address - Fax:915-566-7682
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113846225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207164901Medicaid
TX149984001Medicaid
TX149984001Medicaid
TX456606Medicare PIN