Provider Demographics
NPI:1518551696
Name:ALVAREZ ROSALES, ESPERANZA
Entity Type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:
Last Name:ALVAREZ ROSALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-4200
Mailing Address - Country:US
Mailing Address - Phone:850-272-8813
Mailing Address - Fax:
Practice Address - Street 1:2928 DANIELS ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2912
Practice Address - Country:US
Practice Address - Phone:850-526-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR939207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR939OtherJUNTA DE LICENCIAMIENTO PUERTO RICO