Provider Demographics
NPI:1073628483
Name:ALVAREZ, MANUEL (LSA-C)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:LSA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 ROYAL OAK ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-1502
Mailing Address - Country:US
Mailing Address - Phone:956-778-7293
Mailing Address - Fax:956-350-3819
Practice Address - Street 1:2011 ROYAL OAK ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-1502
Practice Address - Country:US
Practice Address - Phone:956-778-7293
Practice Address - Fax:956-350-3819
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00236363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical