Healthcare Provider Details

I. General information

NPI: 1306259171
Provider Name (Legal Business Name): AARON ALVAREZ IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVE
LANGLEY AFB VA
23665-2040
US

IV. Provider business mailing address

112 BRONCO LN
HAMPTON VA
23665-2570
US

V. Phone/Fax

Practice location:
  • Phone: 757-764-3260
  • Fax:
Mailing address:
  • Phone: 480-842-2875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: