1568652857 NPI number — MISS ALEXANDRA MARIE ALVAREZ ATC

Table of content: MISS ALEXANDRA MARIE ALVAREZ ATC (NPI 1568652857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568652857 NPI number — MISS ALEXANDRA MARIE ALVAREZ ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALVAREZ
Provider First Name:
ALEXANDRA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568652857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PROVIDENCE MEDFORD MEDICAL CENTER
Provider Second Line Business Mailing Address:
1111 CRATER LAKE AVENUE
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-942-1918
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 CRATER LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97504-6241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-942-1918
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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