Provider Demographics
NPI:1457067035
Name:ALVAREZ, KATHERINE MASSIEL (RN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MASSIEL
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3388
Mailing Address - Country:US
Mailing Address - Phone:562-805-7551
Mailing Address - Fax:
Practice Address - Street 1:1333 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2944
Practice Address - Country:US
Practice Address - Phone:562-753-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95251466163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care