Healthcare Provider Details

I. General information

NPI: 1447254891
Provider Name (Legal Business Name): LAURA D ALVEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 ROUTE 4 STE. 103
SINAJANA GUAM
96910
UM

IV. Provider business mailing address

736 ROUTE 4 STE. 103
SINAJANA GUAM
96910
UM

V. Phone/Fax

Practice location:
  • Phone: 671-649-7232
  • Fax: 671-649-7232
Mailing address:
  • Phone: 671-649-7232
  • Fax: 671-649-7232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number18145
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35069336A
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD050934L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM-1632
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: