Healthcare Provider Details

I. General information

NPI: 1639110679
Provider Name (Legal Business Name): SAUL ALVAREZ RRT RPSGT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 MESQUITE AVE #201
LAKE HAVASU CITY AZ
86403
US

IV. Provider business mailing address

1720 MESQUITE AVE #201
LAKE HAVASU CITY AZ
86403
US

V. Phone/Fax

Practice location:
  • Phone: 928-855-7570
  • Fax: 928-855-7574
Mailing address:
  • Phone: 928-855-7570
  • Fax: 928-855-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number01398
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: