Healthcare Provider Details

I. General information

NPI: 1962357434
Provider Name (Legal Business Name): SANTIAGO JOSE SANCHEZ ALVARADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 COLLEGE AVE
GORHAM ME
04038-1099
US

IV. Provider business mailing address

34 RUE DE CHERBOURG
KIRKLAND QUEBEC
H9H5H4
CA

V. Phone/Fax

Practice location:
  • Phone: 580-430-1429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: