=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275723298
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. JFERNANDO ALVAREZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2007
-----------------------------------------------------
Last Update Date | 07/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6449 BELLA CIR UNIT 103
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-596-7166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6449 BELLA CIR UNIT 103
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-5567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-596-7166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN18008
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------