Provider Demographics
NPI:1083638381
Name:ALVARADO, RENE G
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:G
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14451 SW 163RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1719
Mailing Address - Country:US
Mailing Address - Phone:305-254-7099
Mailing Address - Fax:305-254-7099
Practice Address - Street 1:13372 SW 128TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5807
Practice Address - Country:US
Practice Address - Phone:305-254-7099
Practice Address - Fax:305-254-7099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32: 03879332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0749630001Medicare ID - Type Unspecified