Basic Information
| Provider Information | |||||||||
| NPI: | 1063074722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALVES | ||||||||
| FirstName: | PAUL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4920 PENNELL RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | ASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190141867 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4505 PACIFIC HWY E STE C2 | ||||||||
| Address2: | |||||||||
| City: | FIFE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984242638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256407009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2019 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN695718 | PA | N | Nursing Service Providers | Registered Nurse | 363LP0808X | SP020775 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | AP61117435 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.