Provider Demographics
NPI:1992543417
Name:ALVAREZ, MONICA ROSALIE FARIA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ROSALIE FARIA
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:ROSALIE
Other - Last Name:FARIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:15085 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-3388
Mailing Address - Country:US
Mailing Address - Phone:623-696-0856
Mailing Address - Fax:
Practice Address - Street 1:13835 N TATUM BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5581
Practice Address - Country:US
Practice Address - Phone:602-380-6807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-008284225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist