=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558525899
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORGE LUIS ALVAREZ SR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2008
-----------------------------------------------------
Last Update Date | 07/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4121 ABRAMS AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89110-5795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-218-8008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 169
-----------------------------------------------------
City | ARROYO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00714-0169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-218-8008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 17,202
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------