Provider Demographics
NPI:1295107902
Name:ALVAREZ MARTINEZ, GERARDO ENRIQUE (LSA)
Entity type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:ENRIQUE
Last Name:ALVAREZ MARTINEZ
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1148 SILBER RD APT 1103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7145
Mailing Address - Country:US
Mailing Address - Phone:786-448-0821
Mailing Address - Fax:
Practice Address - Street 1:8726 CEDARDALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4809
Practice Address - Country:US
Practice Address - Phone:832-808-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00723363AS0400X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant