Healthcare Provider Details

I. General information

NPI: 1750164224
Provider Name (Legal Business Name): JENNIFER MABEL ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12391 SHINING WILLOW ST
RIVERVIEW FL
33579-6868
US

IV. Provider business mailing address

12391 SHINING WILLOW ST
RIVERVIEW FL
33579-6868
US

V. Phone/Fax

Practice location:
  • Phone: 786-837-1539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: