Provider Demographics
NPI:1104480557
Name:ALVAREZ, JACQUELINE
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3930 RIVE GAUCHE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2426
Mailing Address - Country:US
Mailing Address - Phone:702-971-1994
Mailing Address - Fax:
Practice Address - Street 1:3468 E SAHARA AVE STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-4827
Practice Address - Country:US
Practice Address - Phone:702-431-2232
Practice Address - Fax:702-431-2598
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty