Healthcare Provider Details

I. General information

NPI: 1053205443
Provider Name (Legal Business Name): MARIELA V ALVARADO-ALEMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIELA VIVIANA ALVARADO ALEMAN PA-C

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 FIRST COLONIAL RD STE 300
VIRGINIA BEACH VA
23454-2432
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 757-333-8001
  • Fax: 757-333-8002
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011034
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: