Healthcare Provider Details

I. General information

NPI: 1629182795
Provider Name (Legal Business Name): GILBERTO T ALVARADO CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2474 INDIAN WELLS RD SUITE A
ALAMOGORDO NM
88310-3845
US

IV. Provider business mailing address

2474 INDIAN WELLS RD SUITE A
ALAMOGORDO NM
88310-3845
US

V. Phone/Fax

Practice location:
  • Phone: 575-415-1927
  • Fax: 575-532-8963
Mailing address:
  • Phone: 575-415-1927
  • Fax: 575-532-8963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR47487
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP01162
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: