Healthcare Provider Details

I. General information

NPI: 1689371908
Provider Name (Legal Business Name): SERGIO ALBERTO ALVAREZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD STE 101
NAPLES FL
34119-3900
US

IV. Provider business mailing address

3451 PINE RIDGE RD BLDG 601
NAPLES FL
34109-3922
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-1662
  • Fax: 239-649-7053
Mailing address:
  • Phone: 239-449-3072
  • Fax: 877-334-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117067
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9117067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: