Provider Demographics
NPI:1295428084
Name:ALVA FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:ALVA FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:TERRAZAS
Authorized Official - Last Name:ALVA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:432-312-2491
Mailing Address - Street 1:6908 BOOT RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2440
Mailing Address - Country:US
Mailing Address - Phone:432-312-2491
Mailing Address - Fax:432-400-1415
Practice Address - Street 1:6908 BOOT RANCH RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2440
Practice Address - Country:US
Practice Address - Phone:432-312-2491
Practice Address - Fax:432-400-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care