Healthcare Provider Details

I. General information

NPI: 1487631719
Provider Name (Legal Business Name): LUZ FABIOLA ALVAREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 S KINGSBORO AVE
JOHNSTOWN NY
12095-3822
US

IV. Provider business mailing address

99 E STATE ST PO BOX 1250
GLOVERSVILLE NY
12078-1203
US

V. Phone/Fax

Practice location:
  • Phone: 518-752-5275
  • Fax: 518-752-5277
Mailing address:
  • Phone: 518-775-4205
  • Fax: 518-775-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number168586
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: