Provider Demographics
NPI:1053135277
Name:ALVAREZ, JAQUELIN
Entity type:Individual
Prefix:
First Name:JAQUELIN
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 481024
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-9624
Mailing Address - Country:US
Mailing Address - Phone:213-313-4080
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 481024
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-9624
Practice Address - Country:US
Practice Address - Phone:213-313-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1185301041C0700X
CA1185301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical