Provider Demographics
NPI:1841424181
Name:ALVARADO, SERGIO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:ANTONIO
Last Name:ALVARADO
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 1:1729 WESTON BRENT LN STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3013
Mailing Address - Country:US
Mailing Address - Phone:915-256-9751
Mailing Address - Fax:915-974-2344
Practice Address - Street 1:2267 TRAWOOD DR STE G2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3027
Practice Address - Country:US
Practice Address - Phone:915-256-9751
Practice Address - Fax:915-974-2344
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7738207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331389201Medicaid
TX331587YMUWOtherMEDICARE