Provider Demographics
NPI:1982078911
Name:ALVAREZ, CRYSTAL ANGELICA (LMP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANGELICA
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5408
Mailing Address - Country:US
Mailing Address - Phone:509-679-5796
Mailing Address - Fax:
Practice Address - Street 1:901 4TH ST SE
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5408
Practice Address - Country:US
Practice Address - Phone:509-679-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA606324996225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist