Provider Demographics
NPI:1154100980
Name:ALVAREZ, ALAN RODNEY (LPT)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:RODNEY
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3034 EARLE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2639
Mailing Address - Country:US
Mailing Address - Phone:626-905-1226
Mailing Address - Fax:
Practice Address - Street 1:3034 EARLE AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2639
Practice Address - Country:US
Practice Address - Phone:626-905-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42588167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes167G00000XNursing Service ProvidersLicensed Psychiatric TechnicianGroup - Single Specialty