Healthcare Provider Details

I. General information

NPI: 1922020726
Provider Name (Legal Business Name): WANDA VIRGINIA ALVIRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 W CENTRAL BLVD
ORLANDO FL
32805-1809
US

IV. Provider business mailing address

10078 SILK GRASS DR
ORLANDO FL
32827-7038
US

V. Phone/Fax

Practice location:
  • Phone: 407-723-4049
  • Fax:
Mailing address:
  • Phone: 407-579-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberACN281
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11664
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: