Provider Demographics
NPI:1255773313
Name:ALVAREZ GONZALEZ, ERICA RENEE (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:RENEE
Last Name:ALVAREZ GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-2503
Mailing Address - Country:US
Mailing Address - Phone:915-200-1203
Mailing Address - Fax:534-429-4340
Practice Address - Street 1:3100 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2503
Practice Address - Country:US
Practice Address - Phone:915-888-9145
Practice Address - Fax:534-429-4340
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7160207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX386751703Medicaid
OH0230957Medicaid