=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811364672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISRAEL D. ALVAREZ, M.D.,FAAP; ALVIS PEDIATRICS,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2015
-----------------------------------------------------
Last Update Date | 01/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18300 NW 62ND AVE SUITE 230
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33015-8200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-623-4444
-----------------------------------------------------
Fax | 305-623-9720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18300 NW 62ND AVE SUITE 230
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33015-8200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-623-4444
-----------------------------------------------------
Fax | 305-623-9720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ISRAEL DAVID ALVAREZ
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 305-623-5766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | ME57185
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------