Provider Demographics
NPI:1528473378
Name:ALVARADO, LUIS (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3318
Mailing Address - Country:US
Mailing Address - Phone:415-457-2487
Mailing Address - Fax:415-457-5687
Practice Address - Street 1:910 IRWIN ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3318
Practice Address - Country:US
Practice Address - Phone:415-457-2487
Practice Address - Fax:415-457-5687
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24347103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical