=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407836836
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALVARO MAYORGA-CORTES MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2006
-----------------------------------------------------
Last Update Date | 05/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8950 N KENDALL DR SUITE 405
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-412-7225
-----------------------------------------------------
Fax | 305-412-7229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10750 LAKESIDE DR
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-632-7520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME22452
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------