Provider Demographics
NPI:1578891859
Name:ALVARADO, FABIAN (FNP)
Entity Type:Individual
Prefix:
First Name:FABIAN
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 FREEDOM BLVD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2780
Mailing Address - Country:US
Mailing Address - Phone:831-728-2505
Mailing Address - Fax:831-728-2636
Practice Address - Street 1:29 BISHOP ST STE A
Practice Address - Street 2:
Practice Address - City:ROYAL OAKS
Practice Address - State:CA
Practice Address - Zip Code:95076-5266
Practice Address - Country:US
Practice Address - Phone:831-728-2505
Practice Address - Fax:831-728-2636
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP19343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00NP19343Medicaid