Provider Demographics
NPI:1174256176
Name:DIAZ ALVARADO, WILLIAM MAURICIO
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MAURICIO
Last Name:DIAZ 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 1:15 LACROIX COURT DR APT B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-1515
Mailing Address - Country:US
Mailing Address - Phone:786-843-9803
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTLAND AVE BLDG 3
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3095
Practice Address - Country:US
Practice Address - Phone:585-922-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program