Provider Demographics
NPI:1720620172
Name:ALVARADO- MONTIEL, MAURILIA ARACELI
Entity type:Individual
Prefix:
First Name:MAURILIA
Middle Name:ARACELI
Last Name:ALVARADO- MONTIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAURILIA
Other - Middle Name:ARACELI
Other - Last Name:ALVARADO- MONTIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:820 E GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0928
Mailing Address - Country:US
Mailing Address - Phone:909-387-7200
Mailing Address - Fax:
Practice Address - Street 1:820 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0928
Practice Address - Country:US
Practice Address - Phone:909-387-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator