Provider Demographics
NPI:1255078424
Name:ALFARO, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:ALFARO
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 1:77777 COUNTRY CLUB DR APT 234
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0464
Mailing Address - Country:US
Mailing Address - Phone:760-619-1909
Mailing Address - Fax:
Practice Address - Street 1:255 E RINCON ST STE 219
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1387
Practice Address - Country:US
Practice Address - Phone:951-817-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician