Healthcare Provider Details

I. General information

NPI: 1831427376
Provider Name (Legal Business Name): GABRIEL ALVARADO CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 TERRY LN
LYTLE TX
78052-3829
US

IV. Provider business mailing address

140 TERRY LN
LYTLE TX
78052-3829
US

V. Phone/Fax

Practice location:
  • Phone: 210-273-6752
  • Fax:
Mailing address:
  • Phone: 210-273-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3522
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: