Healthcare Provider Details

I. General information

NPI: 1952784662
Provider Name (Legal Business Name): MARIA VIRGINIA ROMERO ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE # 33136
MIAMI FL
33136-1096
US

IV. Provider business mailing address

2100 DORCHESTER AVE
DORCHESTER MA
02124-5615
US

V. Phone/Fax

Practice location:
  • Phone: 617-548-4972
  • Fax:
Mailing address:
  • Phone: 617-548-4972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number263870
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number47074
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: