Provider Demographics
NPI:1609866367
Name:ALVAREZ GONZALEZ, SAMUEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:ALVAREZ GONZALEZ
Suffix:
Gender:M
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:PO BOX 6425
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5425
Mailing Address - Country:US
Mailing Address - Phone:787-630-0804
Mailing Address - Fax:787-799-4023
Practice Address - Street 1:EDIFICIO PROFESIONAL MENONITA
Practice Address - Street 2:SUITE 302
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-630-0804
Practice Address - Fax:787-735-7390
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR070213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0048082Medicare ID - Type Unspecified
U64336Medicare UPIN