Healthcare Provider Details

I. General information

NPI: 1396371084
Provider Name (Legal Business Name): JEREMY ALVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 W ORTEGA ST APT F
SANTA BARBARA CA
93101-6445
US

IV. Provider business mailing address

631 W ORTEGA ST APT F
SANTA BARBARA CA
93101-6445
US

V. Phone/Fax

Practice location:
  • Phone: 361-739-6858
  • Fax:
Mailing address:
  • Phone: 361-739-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number207PS0010X
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: