Provider Demographics
NPI:1073632634
Name:ALVARADO-AHUMADA, SALESIA (MD)
Entity Type:Individual
Prefix:
First Name:SALESIA
Middle Name:
Last Name:ALVARADO-AHUMADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE VILLAGES VA OUTPATIENT CLINIC
Mailing Address - Street 2:8900 SE 165TH MULBERRY LN.
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162
Mailing Address - Country:US
Mailing Address - Phone:352-674-5000
Mailing Address - Fax:
Practice Address - Street 1:2230 SW 19TH AVENUE RD
Practice Address - Street 2:BUILDING # 200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1391
Practice Address - Country:US
Practice Address - Phone:352-237-4133
Practice Address - Fax:352-237-7728
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279954500Medicaid
FLAH802ZMedicare PIN
FLH37112Medicare UPIN
FLAH802WMedicare PIN
FLAH802YMedicare PIN
FLAH802XMedicare PIN
FLP00456879Medicare PIN
FLAH802VMedicare PIN