Provider Demographics
NPI:1063654317
Name:ALVIDREZ, LUIS (CPT, CSCS CERTIFIED)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:ALVIDREZ
Suffix:
Gender:M
Credentials:CPT, CSCS CERTIFIED
Other - Prefix:MR
Other - First Name:LUIS
Other - Middle Name:
Other - Last Name:ALVIDREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPT,CSCS CERTIFIED
Mailing Address - Street 1:336 ADAMS ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2837
Mailing Address - Country:US
Mailing Address - Phone:505-268-1231
Mailing Address - Fax:505-268-1968
Practice Address - Street 1:336 ADAMS ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2837
Practice Address - Country:US
Practice Address - Phone:505-268-1231
Practice Address - Fax:505-268-1968
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1349767174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist