Provider Demographics
NPI:1750515698
Name:ELENITA V. ALVAREZ, MD., INC.
Entity type:Organization
Organization Name:ELENITA V. ALVAREZ, MD., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:GISSELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-521-9847
Mailing Address - Street 1:321 NORTH KUAKINI STREET, SUITE510
Mailing Address - Street 2:
Mailing Address - City:HONOLULU,
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2361
Mailing Address - Country:US
Mailing Address - Phone:808-521-9847
Mailing Address - Fax:808-521-7236
Practice Address - Street 1:321 NORTH KUAKINI STREET, SUITE510
Practice Address - Street 2:
Practice Address - City:HONOLULU,
Practice Address - State:HI
Practice Address - Zip Code:96817-2361
Practice Address - Country:US
Practice Address - Phone:808-521-9847
Practice Address - Fax:808-521-7236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3322174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04055601Medicaid
HIB44657OtherHMSA
HI04055601Medicaid