Provider Demographics
NPI:1609497296
Name:ALVAREZ SANTOS, ERIDELVIS
Entity Type:Individual
Prefix:
First Name:ERIDELVIS
Middle Name:
Last Name:ALVAREZ SANTOS
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 1:6841 SW 129TH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2464
Mailing Address - Country:US
Mailing Address - Phone:786-370-4375
Mailing Address - Fax:
Practice Address - Street 1:6841 SW 129TH AVE APT 8
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2464
Practice Address - Country:US
Practice Address - Phone:786-370-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-116441106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty