Provider Demographics
NPI:1316595457
Name:ALVAREZ PRADO, DAMARYS AMPARO
Entity Type:Individual
Prefix:
First Name:DAMARYS
Middle Name:AMPARO
Last Name:ALVAREZ PRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 20TH ST APT 312
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2524
Mailing Address - Country:US
Mailing Address - Phone:786-491-0145
Mailing Address - Fax:
Practice Address - Street 1:315 W 20TH ST APT 312
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2524
Practice Address - Country:US
Practice Address - Phone:786-491-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty