Provider Demographics
NPI:1659869048
Name:ALVAREZ, ALBERTO L (CPO)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:L
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 WASHINGTON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3102
Mailing Address - Country:US
Mailing Address - Phone:228-864-4512
Mailing Address - Fax:228-864-5339
Practice Address - Street 1:3506 WASHINGTON AVE STE D
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3102
Practice Address - Country:US
Practice Address - Phone:228-864-4512
Practice Address - Fax:228-864-5339
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00040133Medicaid