Healthcare Provider Details

I. General information

NPI: 1508045717
Provider Name (Legal Business Name): KIMBERLY ANN ALVARADO TX. L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18422 LAKELAND DR
LAGO VISTA TX
78645-8702
US

IV. Provider business mailing address

18422 LAKELAND DR
LAGO VISTA TX
78645-8702
US

V. Phone/Fax

Practice location:
  • Phone: 512-422-3699
  • Fax: 512-267-6410
Mailing address:
  • Phone: 512-422-3699
  • Fax: 512-267-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00638
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: