Provider Demographics
NPI:1265481733
Name:ALVARADO HERNANDEZ, LUIS ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:ALVARADO HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 SANTA BARBARA BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6827
Mailing Address - Country:US
Mailing Address - Phone:352-259-2159
Mailing Address - Fax:352-259-5731
Practice Address - Street 1:1580 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6827
Practice Address - Country:US
Practice Address - Phone:352-259-2159
Practice Address - Fax:352-259-5731
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1024207V00000X
PR12056207V00000X
FLME138871207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJG925ZOtherMEDICARE
FL023989100Medicaid