Healthcare Provider Details

I. General information

NPI: 1912013699
Provider Name (Legal Business Name): JOSE A ALVAREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E NASA BLVD STE 200
MELBOURNE FL
32901-1954
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-723-9175
  • Fax: 321-723-9176
Mailing address:
  • Phone: 321-361-5618
  • Fax: 321-951-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME94890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: