Provider Demographics
NPI:1477126647
Name:ALVAREZ GARCIA, GABRIEL
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:ALVAREZ GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5556 S INTEGRITY LN
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-8861
Mailing Address - Country:US
Mailing Address - Phone:602-541-0212
Mailing Address - Fax:
Practice Address - Street 1:5556 S INTEGRITY LN
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-8861
Practice Address - Country:US
Practice Address - Phone:602-541-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN179542163WS0200X
AZ268440367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WS0200XNursing Service ProvidersRegistered NurseSchool