Provider Demographics
NPI:1538827431
Name:ALMENDARIZ, ALFONSO (AMFT)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:ALMENDARIZ
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHIMNEY ROCK DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7737
Mailing Address - Country:US
Mailing Address - Phone:707-592-6231
Mailing Address - Fax:
Practice Address - Street 1:1745 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-927-4282
Practice Address - Fax:707-247-4233
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist