Provider Demographics
NPI:1376415505
Name:UMANZOR-ALVARADO, ALICIA ESTEPHANY
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ESTEPHANY
Last Name:UMANZOR-ALVARADO
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 1:2710 N TOWNE AVE # 433
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-6412
Mailing Address - Country:US
Mailing Address - Phone:973-738-9765
Mailing Address - Fax:
Practice Address - Street 1:2710 N TOWNE AVE # 433
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-6412
Practice Address - Country:US
Practice Address - Phone:973-738-9765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty