Basic Information
| Provider Information | |||||||||
| NPI: | 1649511429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALVARADO | ||||||||
| FirstName: | MARISELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 PARK COURT PL BLDG H | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927015028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149571004 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1801 PARK COURT PL BLDG H | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927015028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149571004 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2013 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-11-8798 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.