Healthcare Provider Details

I. General information

NPI: 1629761176
Provider Name (Legal Business Name): EVARISTO SAN JOSE ALVAREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5961 NW 173RD DR
HIALEAH FL
33015-5114
US

IV. Provider business mailing address

5961 NW 173RD DR
HIALEAH FL
33015-5114
US

V. Phone/Fax

Practice location:
  • Phone: 305-556-7500
  • Fax:
Mailing address:
  • Phone: 305-556-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37108
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: