Basic Information
| Provider Information | |||||||||
| NPI: | 1457665127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALVAREZ | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ARACELI | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 405 PAMELA KAY LN | ||||||||
| Address2: | |||||||||
| City: | LA PUENTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917462729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264210250 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11001 VALLEY MALL | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917312620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264420710 | ||||||||
| FaxNumber: | 6264478381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2010 | ||||||||
| LastUpdateDate: | 08/04/2010 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | ICAN883 | 01 | CA | LA COUNTY DMH STAFF CODE | OTHER |