Provider Demographics
NPI:1467424143
Name:ALVARADO LOPEZ, LUIS RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAFAEL
Last Name:ALVARADO LOPEZ
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 1:8750 NW 36TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2499
Mailing Address - Country:US
Mailing Address - Phone:786-391-0187
Mailing Address - Fax:305-907-6099
Practice Address - Street 1:595 OAK COMMONS BLVD STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:321-249-6954
Practice Address - Fax:407-483-7834
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN794OtherMEDICAL LICENSE
FLIR541ZOtherMEDICARE PTAN
PRPG3618OtherPANAMERICAN LIFE INS. CO.
PR88605-ALOtherTRIPLE S
PR3237-1OtherPROSSAM
PRH81614Medicare UPIN
PR0088605Medicare ID - Type UnspecifiedMEDICARE