Healthcare Provider Details

I. General information

NPI: 1497353593
Provider Name (Legal Business Name): JOSE DE JESUS ALVARADO VELOZ SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MANGO RD
EL PASO TX
79915-4314
US

IV. Provider business mailing address

216 MANGO RD
EL PASO TX
79915-4314
US

V. Phone/Fax

Practice location:
  • Phone: 915-301-7523
  • Fax:
Mailing address:
  • Phone: 915-301-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number20-396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: