Provider Demographics
NPI:1720406572
Name:ALVAREZ, JACQUELINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10401 SPOTSYLVANIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8606
Mailing Address - Country:US
Mailing Address - Phone:540-361-1000
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7115
Practice Address - Country:US
Practice Address - Phone:206-598-6483
Practice Address - Fax:206-543-6317
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-30
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012688762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology