Provider Demographics
NPI:1104336429
Name:ALVARADO, ALFREDO ENRIQUE
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:ENRIQUE
Last Name:ALVARADO
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 1:33255 9TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-2137
Mailing Address - Country:US
Mailing Address - Phone:510-471-5880
Mailing Address - Fax:510-690-0703
Practice Address - Street 1:33255 9TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-2137
Practice Address - Country:US
Practice Address - Phone:510-471-5880
Practice Address - Fax:510-690-0703
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker