Healthcare Provider Details

I. General information

NPI: 1295107902
Provider Name (Legal Business Name): GERARDO ENRIQUE ALVAREZ MARTINEZ LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8726 CEDARDALE DR
HOUSTON TX
77055-4809
US

IV. Provider business mailing address

1148 SILBER RD APT 1103
HOUSTON TX
77055-7145
US

V. Phone/Fax

Practice location:
  • Phone: 832-808-3502
  • Fax:
Mailing address:
  • Phone: 786-448-0821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA00723
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: