Provider Demographics
NPI:1336674761
Name:DU, ALVIN AMBOY
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:AMBOY
Last Name:DU
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 1:3890 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-7186
Mailing Address - Country:US
Mailing Address - Phone:352-674-4744
Mailing Address - Fax:800-866-8368
Practice Address - Street 1:3890 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-7186
Practice Address - Country:US
Practice Address - Phone:352-674-4744
Practice Address - Fax:800-866-8368
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 29668174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist