Provider Demographics
NPI:1821541897
Name:ALVIZO, EVERARDO
Entity Type:Individual
Prefix:
First Name:EVERARDO
Middle Name:
Last Name:ALVIZO
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 1:2525 GRAND AVE # 115
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1765
Mailing Address - Country:US
Mailing Address - Phone:562-570-4435
Mailing Address - Fax:562-570-4106
Practice Address - Street 1:2525 GRAND AVE # 115
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1765
Practice Address - Country:US
Practice Address - Phone:562-570-4435
Practice Address - Fax:562-570-4106
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1007821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical