Provider Demographics
NPI:1710579198
Name:ALVAREZ, PEDRO MANUEL (PA-C)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:MANUEL
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7941 SW 152ND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3217
Mailing Address - Country:US
Mailing Address - Phone:305-717-8156
Mailing Address - Fax:
Practice Address - Street 1:2734 SW 37TH AVE
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-2728
Practice Address - Country:US
Practice Address - Phone:305-642-4263
Practice Address - Fax:305-426-3329
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113765363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical