Healthcare Provider Details

I. General information

NPI: 1295661569
Provider Name (Legal Business Name): CAMILO ALVARADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 W HICKPOCHEE AVE
LABELLE FL
33935-4753
US

IV. Provider business mailing address

5557 NW 90TH TER
SUNRISE FL
33351-7774
US

V. Phone/Fax

Practice location:
  • Phone: 863-675-0387
  • Fax:
Mailing address:
  • Phone: 954-608-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH31535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: