Provider Demographics
NPI:1184164246
Name:ALVAREZ, ANIURKA Y (020015900)
Entity type:Individual
Prefix:
First Name:ANIURKA
Middle Name:Y
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:020015900
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SPARROW DR APT 208
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1620
Mailing Address - Country:US
Mailing Address - Phone:561-248-5297
Mailing Address - Fax:
Practice Address - Street 1:120 SPARROW DR APT 208
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1620
Practice Address - Country:US
Practice Address - Phone:561-248-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7248023183700000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020015900Medicaid