Provider Demographics
NPI:1760159776
Name:ALVAREZ GONZALEZ, JEAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:CARLOS
Last Name:ALVAREZ GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CALLE ALMONTE APT 508
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2413
Mailing Address - Country:US
Mailing Address - Phone:787-629-1381
Mailing Address - Fax:
Practice Address - Street 1:CARR 931 KM 5.5 BO NAVARRO PRADERAS SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-743-1985
Practice Address - Fax:787-744-6276
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22524208D00000X
PR1054PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1054PAOtherPHYSICIAN ASSITANT LICENCE
PR22524Medicaid