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General NPI Number Information
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NPI Number | 1336799204
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Entity Type | Individual
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Provider Name | MARTHA ALVAREZ PA
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Gender | Female
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 725 N ASHLEY RIDGE LOOP STE 100
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City | SHREVEPORT
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State | LA
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Zip | 71106-7233
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Country | US
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Telephone | 318-616-6011
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 FERN AVE STE 700A
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City | SHREVEPORT
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State | LA
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Zip | 71105-5673
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 321109
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License Number State | LA
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