Healthcare Provider Details

I. General information

NPI: 1043620586
Provider Name (Legal Business Name): STEFANIE MARIE ALVARADO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEFANIE MARIE BUTERA

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 CEDAR SPRINGS RD
DALLAS TX
75219-3520
US

IV. Provider business mailing address

4012 CEDAR SPRINGS RD
DALLAS TX
75219-3520
US

V. Phone/Fax

Practice location:
  • Phone: 214-528-2336
  • Fax: 214-528-8436
Mailing address:
  • Phone: 214-528-2336
  • Fax: 214-528-8436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: