Healthcare Provider Details

I. General information

NPI: 1053379115
Provider Name (Legal Business Name): JAIME ALVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9075 SW 87TH AVE STE 414
MIAMI FL
33176
US

IV. Provider business mailing address

9075 SW 87TH AVE STE 414
MIAMI FL
33176-2308
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-5060
  • Fax: 305-274-0003
Mailing address:
  • Phone: 305-273-5060
  • Fax: 305-274-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME55208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: