Healthcare Provider Details

I. General information

NPI: 1609220698
Provider Name (Legal Business Name): PEDRO MIGUEL ALVAREZ SOTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2016
Last Update Date: 06/29/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE STE 4070
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE STE 4070
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4960
  • Fax: 305-243-3634
Mailing address:
  • Phone: 305-243-4960
  • Fax: 305-243-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME162487
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME162487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: