Provider Demographics
NPI:1952000630
Name:ALVAREZ, JUAN J
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810SW 240
Mailing Address - Street 2:
Mailing Address - City:PRINCESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33032
Mailing Address - Country:US
Mailing Address - Phone:305-300-5022
Mailing Address - Fax:
Practice Address - Street 1:10810SW 240
Practice Address - Street 2:
Practice Address - City:PRINCESTON
Practice Address - State:FL
Practice Address - Zip Code:33032
Practice Address - Country:US
Practice Address - Phone:305-300-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-253359106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician