Healthcare Provider Details

I. General information

NPI: 1932110608
Provider Name (Legal Business Name): MIGUEL EDWARD ALVIDREZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

IV. Provider business mailing address

325 S WILLIS ST
VISALIA CA
93291-6105
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-2215
  • Fax:
Mailing address:
  • Phone: 510-350-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPF12405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: