Provider Demographics
NPI:1063002103
Name:ALVAREZ DOMINGUEZ, JAUN EDUARDO
Entity Type:Individual
Prefix:MR
First Name:JAUN
Middle Name:EDUARDO
Last Name:ALVAREZ DOMINGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SHEYSON
Other - Middle Name:ALFONSO
Other - Last Name:MORALES ALMEIDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6750 NW 106TH AVE
Mailing Address - Street 2:6750 NW 106TH AVE
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178
Mailing Address - Country:US
Mailing Address - Phone:786-961-0348
Mailing Address - Fax:
Practice Address - Street 1:6750 NW 106TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178
Practice Address - Country:US
Practice Address - Phone:786-961-0348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker