Provider Demographics
NPI:1033222856
Name:MADRIZ, ALVARO L (PA)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:L
Last Name:MADRIZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15175 EAGLE NEST LN
Mailing Address - Street 2:SUITE #108
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2244
Mailing Address - Country:US
Mailing Address - Phone:305-824-1107
Mailing Address - Fax:305-558-0570
Practice Address - Street 1:15175 EAGLE NEST LN
Practice Address - Street 2:SUITE #108
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2244
Practice Address - Country:US
Practice Address - Phone:305-824-1107
Practice Address - Fax:305-558-0570
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100379363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP83937Medicare UPIN
FLU0261YMedicare ID - Type Unspecified
FLU0261VMedicare ID - Type Unspecified