Basic Information
| Provider Information | |||||||||
| NPI: | 1720189939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALVARELLOS | ||||||||
| FirstName: | MIGUEL | ||||||||
| MiddleName: | ANGEL DARIO | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8502 E CHAPMAN AVE # 235 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928692461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102221605 | ||||||||
| FaxNumber: | 7148388830 | ||||||||
| Practice Location | |||||||||
| Address1: | 260 COHASSET RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308945933 | ||||||||
| FaxNumber: | 7148388830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A94524 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 00A94524 | 05 | CA | MEDICAID |