Provider Demographics
NPI:1326692815
Name:ALVAREZ, ISIDRO JOSE J
Entity Type:Individual
Prefix:
First Name:ISIDRO JOSE
Middle Name:J
Last Name:ALVAREZ
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 1:11215 POINT SYLVAN CIR APT E
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6050
Mailing Address - Country:US
Mailing Address - Phone:571-758-9529
Mailing Address - Fax:
Practice Address - Street 1:11215 POINT SYLVAN CIR APT E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6050
Practice Address - Country:US
Practice Address - Phone:571-758-9529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA416410831070172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty