Provider Demographics
NPI:1649236654
Name:ALVARADO-SANTOS, ANA IVETTE (M D)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:IVETTE
Last Name:ALVARADO-SANTOS
Suffix:
Gender:F
Credentials:M D
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 1332
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-1332
Mailing Address - Country:US
Mailing Address - Phone:787-923-0062
Mailing Address - Fax:352-350-6153
Practice Address - Street 1:8900 SE 165TH MULBERRY LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5884
Practice Address - Country:US
Practice Address - Phone:352-674-5000
Practice Address - Fax:352-384-7954
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89063 ALMedicare ID - Type Unspecified
PRG50657Medicare UPIN