Healthcare Provider Details

I. General information

NPI: 1437115557
Provider Name (Legal Business Name): GILBERTO ALVAREZ-COLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 EAST NIZHONI BLVD
GALLUP NM
87301-1337
US

IV. Provider business mailing address

PO BOX 1337
GALLUP NM
87305-1337
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1290
  • Fax: 505-722-1268
Mailing address:
  • Phone: 505-722-1290
  • Fax: 505-722-1268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12917
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: