Provider Demographics
NPI:1083282313
Name:ALVAREZ, DESIREE CHARLENE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:CHARLENE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 S ANAHEIM BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6258
Mailing Address - Country:US
Mailing Address - Phone:714-948-7641
Mailing Address - Fax:714-689-1381
Practice Address - Street 1:1360 S ANAHEIM BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6258
Practice Address - Country:US
Practice Address - Phone:714-948-7641
Practice Address - Fax:714-689-1381
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist