Healthcare Provider Details

I. General information

NPI: 1639803596
Provider Name (Legal Business Name): REBECA ANA ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12380 SW 82ND AVE
PINECREST FL
33156-5223
US

IV. Provider business mailing address

902 CAPRI ST
CORAL GABLES FL
33134-2500
US

V. Phone/Fax

Practice location:
  • Phone: 786-242-5710
  • Fax:
Mailing address:
  • Phone: 786-512-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ10386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: