Provider Demographics
NPI:1225917396
Name:ALVAREZ, YACKELINE
Entity type:Individual
Prefix:
First Name:YACKELINE
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S GRAND AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1655
Mailing Address - Country:US
Mailing Address - Phone:714-787-8543
Mailing Address - Fax:
Practice Address - Street 1:120 S GRAND AVE APT 13
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1655
Practice Address - Country:US
Practice Address - Phone:714-787-8543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW131714390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program