Healthcare Provider Details

I. General information

NPI: 1659869048
Provider Name (Legal Business Name): ALBERTO L ALVAREZ CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 WASHINGTON AVE STE D
GULFPORT MS
39507-3102
US

IV. Provider business mailing address

3506 WASHINGTON AVE STE D
GULFPORT MS
39507-3102
US

V. Phone/Fax

Practice location:
  • Phone: 228-864-4512
  • Fax: 228-864-5339
Mailing address:
  • Phone: 228-864-4512
  • Fax: 228-864-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: