Provider Demographics
NPI:1740460682
Name:BOCA RATON FAMILY AND PEDIATRIC CLINIC PL
Entity type:Organization
Organization Name:BOCA RATON FAMILY AND PEDIATRIC CLINIC PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-477-2862
Mailing Address - Street 1:19801 HAMPTON DR
Mailing Address - Street 2:C1-2
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2840
Mailing Address - Country:US
Mailing Address - Phone:561-477-2862
Mailing Address - Fax:561-477-2864
Practice Address - Street 1:19801 HAMPTON DR
Practice Address - Street 2:C1-2
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2840
Practice Address - Country:US
Practice Address - Phone:561-477-2862
Practice Address - Fax:561-477-2864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98571207Q00000X
FLME98037207Q00000X
FLME97494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty