Provider Demographics
NPI:1629358437
Name:ALVARADO, ERNESTO
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5508
Mailing Address - Country:US
Mailing Address - Phone:530-894-8008
Mailing Address - Fax:530-342-3995
Practice Address - Street 1:130 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5508
Practice Address - Country:US
Practice Address - Phone:530-894-8008
Practice Address - Fax:530-342-3995
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA372151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health