Provider Demographics
NPI:1013581438
Name:DERAS ALVARENGA, RENE A (DPM)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:A
Last Name:DERAS ALVARENGA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1810
Mailing Address - Country:US
Mailing Address - Phone:347-463-6648
Mailing Address - Fax:
Practice Address - Street 1:2964 LEANN DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-8092
Practice Address - Country:US
Practice Address - Phone:301-917-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692191213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty