Healthcare Provider Details

I. General information

NPI: 1609866367
Provider Name (Legal Business Name): SAMUEL ALVAREZ GONZALEZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO PROFESIONAL MENONITA SUITE 302
AIBONITO PR
00705
US

IV. Provider business mailing address

PO BOX 6425
BAYAMON PR
00960-5425
US

V. Phone/Fax

Practice location:
  • Phone: 787-630-0804
  • Fax: 787-735-7390
Mailing address:
  • Phone: 787-630-0804
  • Fax: 787-799-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number070
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: