Provider Demographics
NPI:1659884930
Name:ALVAREZ, RANDY
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13251 CORBEL CIR APT 1521
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7867
Mailing Address - Country:US
Mailing Address - Phone:786-731-9190
Mailing Address - Fax:
Practice Address - Street 1:13251 CORBEL CIR APT 1521
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7867
Practice Address - Country:US
Practice Address - Phone:786-731-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician