MEDICARE: AUGUST ANGEL ALVARADO

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1598221707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUGUST ANGEL ALVARADO

Provider Business Mailing Address
First Line	:	119 AZALEA ST
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4801
Country	:	US
Telephone Number	:	863-812-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	5302 S FLORIDA AVE STE 202
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-4910
Country	:	US
Telephone Number	:	863-937-8067
Fax Number	:

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

Provider Enumeration Date	:	02/12/2019
Last Update Date	:	02/12/2019

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