Provider Demographics
NPI:1215797386
Name:ALVAREZ, CHARISMA DAVENE
Entity type:Individual
Prefix:
First Name:CHARISMA
Middle Name:DAVENE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:SAN MIGUEL
Mailing Address - State:NM
Mailing Address - Zip Code:88058-0405
Mailing Address - Country:US
Mailing Address - Phone:575-323-1315
Mailing Address - Fax:833-524-5203
Practice Address - Street 1:125 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1270
Practice Address - Country:US
Practice Address - Phone:575-323-1315
Practice Address - Fax:833-524-5203
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator