Healthcare Provider Details

I. General information

NPI: 1972594158
Provider Name (Legal Business Name): VICTOR MANUEL ALVAREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVENUE A
YUMA AZ
85364-7127
US

IV. Provider business mailing address

PO BOX 4639
YUMA AZ
85366-4639
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-7019
  • Fax: 928-336-7319
Mailing address:
  • Phone: 928-336-7019
  • Fax: 928-336-7319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number7669
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number7669
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: