Provider Demographics
NPI:1851171094
Name:ALVAREZ, RYAN DANIEL
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DANIEL
Last Name:ALVAREZ
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 1:57556 29 PALMS HWY # 181
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2934
Mailing Address - Country:US
Mailing Address - Phone:323-570-7648
Mailing Address - Fax:
Practice Address - Street 1:57949 WINTERS RD
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-0965
Practice Address - Country:US
Practice Address - Phone:323-570-7648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist