MEDICARE: MS. DAMARIS ALVAREZ

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA34460	FL

General Provider Information

NPI Number	:	1578719878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAMARIS ALVAREZ

Provider Business Mailing Address
First Line	:	3914 ANTHONY LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-7746
Country	:	US
Telephone Number	:	407-227-9053
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6803
Country	:	US
Telephone Number	:	407-420-2199
Fax Number	:

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

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/18/2008

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