Provider Demographics
NPI:1114097524
Name:ALVAREZ, AVELINO C
Entity Type:Individual
Prefix:
First Name:AVELINO
Middle Name:C
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AVELINO
Other - Middle Name:C
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:2337 ENDEAVOR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1970
Mailing Address - Country:US
Mailing Address - Phone:956-726-4929
Mailing Address - Fax:956-724-6242
Practice Address - Street 1:2337 ENDEAVOR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-1970
Practice Address - Country:US
Practice Address - Phone:956-726-4929
Practice Address - Fax:956-724-6242
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1303216 03Medicaid
TX1303216 04OtherCIDC
TX1303216 01OtherCIDC
TX1303216 07OtherCIDC
TX1303216 05OtherCIDC
TX1851587950OtherGROUP NPI
TX1303216 01OtherCIDC