Provider Demographics
NPI:1245054840
Name:ALVAREZ-LOPEZ, EDUARDO
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:ALVAREZ-LOPEZ
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 1:519 PRATT CT
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-3478
Mailing Address - Country:US
Mailing Address - Phone:909-524-8040
Mailing Address - Fax:
Practice Address - Street 1:519 PRATT CT
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-3478
Practice Address - Country:US
Practice Address - Phone:909-524-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician