Provider Demographics
NPI:1467973230
Name:ALVAREZ, AUDREY (DPM)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15045 5TH AVE SW #404
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166
Mailing Address - Country:US
Mailing Address - Phone:510-468-9643
Mailing Address - Fax:
Practice Address - Street 1:20130 LAKE CHABOT RD STE 202
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5340
Practice Address - Country:US
Practice Address - Phone:510-581-1484
Practice Address - Fax:510-581-7779
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
CAE5714213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program