Healthcare Provider Details

I. General information

NPI: 1942740501
Provider Name (Legal Business Name): ALEXANDER ALVAREZ ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 NW 3RD AVE
GAINESVILLE FL
32601-5141
US

IV. Provider business mailing address

535 MAHAFFEY DR APT B6
RICHMOND KY
40475-2434
US

V. Phone/Fax

Practice location:
  • Phone: 786-312-6190
  • Fax:
Mailing address:
  • Phone: 786-312-6190
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: