Provider Demographics
NPI:1205617875
Name:ALVAREZ MOREJON, ANA LAURA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LAURA
Last Name:ALVAREZ MOREJON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SW 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1379
Mailing Address - Country:US
Mailing Address - Phone:239-810-5728
Mailing Address - Fax:
Practice Address - Street 1:21 SW 21ST AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1379
Practice Address - Country:US
Practice Address - Phone:239-810-5728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-301774106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician