Healthcare Provider Details

I. General information

NPI: 1922216464
Provider Name (Legal Business Name): ALVARO EFRAIN VISBAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALVARO EFRAIN VISBAL VENTURA MD

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST THIRD FLOOR
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-9976
  • Fax: 954-965-5396
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME101129
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME101129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: