Healthcare Provider Details

I. General information

NPI: 1790623064
Provider Name (Legal Business Name): LUIS JAVIER ALVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2162 S 180 E
PROVO UT
84606-7370
US

IV. Provider business mailing address

1798 CHERYL LN
KISSIMMEE FL
34744-6606
US

V. Phone/Fax

Practice location:
  • Phone: 385-378-5201
  • Fax:
Mailing address:
  • Phone: 407-973-9139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: