Provider Demographics
NPI:1154443307
Name:ALVAREZ, LETTICIA (MED)
Entity Type:Individual
Prefix:
First Name:LETTICIA
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 170112
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-9112
Mailing Address - Country:US
Mailing Address - Phone:773-480-1420
Mailing Address - Fax:773-356-6500
Practice Address - Street 1:11044 S. AVENUE F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:773-480-1420
Practice Address - Fax:773-356-6500
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist