Healthcare Provider Details

I. General information

NPI: 1538535133
Provider Name (Legal Business Name): ISRAEL J ALVARADO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 VILLAGE CENTER CIR # 3-286
LAS VEGAS NV
89134-6299
US

IV. Provider business mailing address

1930 VILLAGE CENTER CIR #3-286
LAS VEGAS NV
89134-6299
US

V. Phone/Fax

Practice location:
  • Phone: 702-809-5483
  • Fax:
Mailing address:
  • Phone: 702-809-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL J ALVARADO
Title or Position: PRESIDENT
Credential: MD
Phone: 702-809-5483