Provider Demographics
NPI:1750144846
Name:INDRIAGO ALVARADO, CESAR AUGUSTO (SURGICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:AUGUSTO
Last Name:INDRIAGO ALVARADO
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 S CONGRESS AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2128
Mailing Address - Country:US
Mailing Address - Phone:866-961-1744
Mailing Address - Fax:
Practice Address - Street 1:1320 N SEMORAN BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3561
Practice Address - Country:US
Practice Address - Phone:866-961-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-636246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant