Provider Demographics
NPI:1750787685
Name:ALVAREZ, RICARDO (RDAEF2)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:RDAEF2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4149 TWEEDY BLVD
Mailing Address - Street 2:STE J
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6167
Mailing Address - Country:US
Mailing Address - Phone:323-567-3333
Mailing Address - Fax:310-820-0177
Practice Address - Street 1:4149 TWEEDY BLVD
Practice Address - Street 2:STE J
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6167
Practice Address - Country:US
Practice Address - Phone:323-567-3333
Practice Address - Fax:310-820-0177
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAEF1732126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant