Provider Demographics
NPI:1821154691
Name:ALVARADO, WILFREDO ROBERTO
Entity Type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:ROBERTO
Last Name:ALVARADO
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 1:4913 N AVERS AVE
Mailing Address - Street 2:APARTMENT 2A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6037
Mailing Address - Country:US
Mailing Address - Phone:773-442-8155
Mailing Address - Fax:
Practice Address - Street 1:4913 N AVERS AVE
Practice Address - Street 2:APARTMENT 2A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-6037
Practice Address - Country:US
Practice Address - Phone:773-442-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide