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 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:407-986-9642
Mailing Address - Fax:689-304-0303
Practice Address - Street 1:1931 S NARCOOSSEE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-7211
Practice Address - Country:US
Practice Address - Phone:407-986-9642
Practice Address - Fax:833-450-5421
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN794207Q00000X, 208D00000X
PR12274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIR541ZOtherMEDICARE PTAN
FLACN794OtherMEDICAL LICENSE
PRPG3618OtherPANAMERICAN LIFE INS. CO.
PR88605-ALOtherTRIPLE S
PR3237-1OtherPROSSAM
PRH81614Medicare UPIN
PR0088605Medicare ID - Type UnspecifiedMEDICARE