Provider Demographics
NPI:1649961343
Name:ALVAREZ HERNANDEZ, MAYURI
Entity type:Individual
Prefix:MS
First Name:MAYURI
Middle Name:
Last Name:ALVAREZ HERNANDEZ
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 1:2136 BASIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-3835
Mailing Address - Country:US
Mailing Address - Phone:941-421-9795
Mailing Address - Fax:
Practice Address - Street 1:2136 BASIN ST
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-3835
Practice Address - Country:US
Practice Address - Phone:941-421-9795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician