Healthcare Provider Details

I. General information

NPI: 1356821938
Provider Name (Legal Business Name): JACQUELINE ADRIENNE ALVAREZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2739 BABCOCK RD
SAN ANTONIO TX
78229-4811
US

IV. Provider business mailing address

2739 BABCOCK RD
SAN ANTONIO TX
78229-4811
US

V. Phone/Fax

Practice location:
  • Phone: 210-616-3250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1069789
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: