Provider Demographics
NPI:1881429710
Name:AMPUDIA, ALVARO ADRIAN (PA-C)
Entity type:Individual
Prefix:
First Name:ALVARO
Middle Name:ADRIAN
Last Name:AMPUDIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9549 SW 163RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1069
Mailing Address - Country:US
Mailing Address - Phone:786-479-1274
Mailing Address - Fax:
Practice Address - Street 1:9549 SW 163RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1069
Practice Address - Country:US
Practice Address - Phone:786-479-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant