Provider Demographics
NPI:1033742861
Name:ALVAREZ VELAZQUEZ, ILEANA (CASE MANAGER SUPV)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:ALVAREZ VELAZQUEZ
Suffix:
Gender:F
Credentials:CASE MANAGER SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4385 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7628
Mailing Address - Country:US
Mailing Address - Phone:305-824-0637
Mailing Address - Fax:305-824-0628
Practice Address - Street 1:4385 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7628
Practice Address - Country:US
Practice Address - Phone:305-824-0637
Practice Address - Fax:305-824-0628
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024264800Medicaid