Provider Demographics
NPI:1124610050
Name:ALVARENGA CRUZ, CRISTIAN GENARO
Entity type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:GENARO
Last Name:ALVARENGA CRUZ
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 1:3511 E 12TH ST UNIT 343
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-3474
Mailing Address - Country:US
Mailing Address - Phone:510-866-4710
Mailing Address - Fax:
Practice Address - Street 1:3001 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2203
Practice Address - Country:US
Practice Address - Phone:510-433-8600
Practice Address - Fax:510-485-7173
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA92222882DMedicaid