Healthcare Provider Details

I. General information

NPI: 1417651084
Provider Name (Legal Business Name): ROSA F. ALVAREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 NW 3RD ST
ALEDO IL
61231-1317
US

IV. Provider business mailing address

3501 KENNEDY BLVD APT 10
UNION CITY NJ
07087-2577
US

V. Phone/Fax

Practice location:
  • Phone: 309-582-9450
  • Fax:
Mailing address:
  • Phone: 646-651-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036181502
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: