Provider Demographics
NPI:1881842946
Name:ALVAREZ, ILIAN (EDD)
Entity Type:Individual
Prefix:
First Name:ILIAN
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S SUNSET AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2808
Mailing Address - Country:US
Mailing Address - Phone:909-263-9641
Mailing Address - Fax:
Practice Address - Street 1:640 S SUNSET AVE STE 105
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2808
Practice Address - Country:US
Practice Address - Phone:909-263-9641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY28928103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health