MEDICARE: ALVARO IBASETA FIDALGO MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	MD
2	390200000X	Student in an Organized Health Care Education/Training Program	TX
3	390200000X	Student in an Organized Health Care Education/Training Program	OH

General Provider Information

NPI Number	:	1427565217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVARO IBASETA FIDALGO MS

Provider Business Mailing Address
First Line	:	6400 FANNIN ST STE 1700
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1526
Country	:	US
Telephone Number	:	713-486-5527
Fax Number	:

Provider Business Practice Location Address
First Line	:	CLEVELAND CLINIC 9500 EUCLID AVENUE/NA-23
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0005
Country	:	US
Telephone Number	:	216-444-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	02/19/2025

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