Provider Demographics
NPI:1184798910
Name:SUPRALVA CORP
Entity type:Organization
Organization Name:SUPRALVA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-402-2251
Mailing Address - Street 1:PO BOX 9655
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-0655
Mailing Address - Country:US
Mailing Address - Phone:787-402-2251
Mailing Address - Fax:787-767-6743
Practice Address - Street 1:PONCE DE LEON AVE #728
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919-1000
Practice Address - Country:US
Practice Address - Phone:787-754-9720
Practice Address - Fax:787-767-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82472Medicare ID - Type Unspecified