Provider Demographics
NPI:1922756535
Name:TIELVES ALVAREZ, SAMUEL Y
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:Y
Last Name:TIELVES ALVAREZ
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 1:11207 SW 125TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4928
Mailing Address - Country:US
Mailing Address - Phone:786-378-3111
Mailing Address - Fax:
Practice Address - Street 1:11207 SW 125TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4928
Practice Address - Country:US
Practice Address - Phone:786-378-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-192891106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113239500Medicaid