Basic Information
| Provider Information | |||||||||
| NPI: | 1174683189 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALVAREZ | ||||||||
| FirstName: | IRAIDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3025 BEYER BLVD STE E101 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921543432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194285533 | ||||||||
| FaxNumber: | 6194285535 | ||||||||
| Practice Location | |||||||||
| Address1: | 3025 BEYER BLVD STE E101 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921543432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194285533 | ||||||||
| FaxNumber: | 6194285535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 03/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.