Healthcare Provider Details

I. General information

NPI: 1639461809
Provider Name (Legal Business Name): ALFREDO ALVAREZ LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MONTAUK LN
PINGREE GROVE IL
60140-9164
US

IV. Provider business mailing address

469 MONTAUK LN
PINGREE GROVE IL
60140-9164
US

V. Phone/Fax

Practice location:
  • Phone: 847-946-0724
  • Fax:
Mailing address:
  • Phone: 847-946-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.010131
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: