Healthcare Provider Details

I. General information

NPI: 1467973230
Provider Name (Legal Business Name): AUDREY ALVAREZ DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 06/26/2022
Certification Date: 06/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20130 LAKE CHABOT RD STE 202
CASTRO VALLEY CA
94546-5340
US

IV. Provider business mailing address

15045 5TH AVE SW #404
BURIEN WA
98166
US

V. Phone/Fax

Practice location:
  • Phone: 510-581-1484
  • Fax: 510-581-7779
Mailing address:
  • Phone: 510-468-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: