Provider Demographics
NPI:1508045717
Name:ALVARADO, KIMBERLY ANN (TX LAC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:TX LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18422 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-8702
Mailing Address - Country:US
Mailing Address - Phone:512-422-3699
Mailing Address - Fax:512-267-6410
Practice Address - Street 1:18422 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-8702
Practice Address - Country:US
Practice Address - Phone:512-422-3699
Practice Address - Fax:512-267-6410
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00638171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist