Provider Demographics
NPI:1003841826
Name:ALVAREZ, SANDRA IVELISSE (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:IVELISSE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:IVELISSE
Other - Last Name:ALVAREZ-BAEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 781124
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32878-1124
Mailing Address - Country:US
Mailing Address - Phone:407-631-1070
Mailing Address - Fax:
Practice Address - Street 1:13800 VETERANS WAY
Practice Address - Street 2:HERO CLINIC 1F
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7401
Practice Address - Country:US
Practice Address - Phone:407-631-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9446OtherINACTIVE PR LICENSE
PR9446OtherINACTIVE PR LICENSE
FLD95214Medicare UPIN
FLBA1933399OtherDEA LICENSE