Healthcare Provider Details

I. General information

NPI: 1790531242
Provider Name (Legal Business Name): ISABELLA MARIE ALVARADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4170 CITY AVE
PHILADELPHIA PA
19131-1694
US

IV. Provider business mailing address

W5437 HORSESHOE PL
LA CROSSE WI
54601-2459
US

V. Phone/Fax

Practice location:
  • Phone: 215-871-6100
  • Fax:
Mailing address:
  • Phone: 608-498-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: