1588087787 NPI number — ALVARO PORRAS TOLEDO LAC, AP

Table of content: ALVARO PORRAS TOLEDO LAC, AP (NPI 1588087787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588087787 NPI number — ALVARO PORRAS TOLEDO LAC, AP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORRAS TOLEDO
Provider First Name:
ALVARO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LAC, AP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOLEDO
Provider Other First Name:
ALVARO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LAC, AP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588087787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3825 SW 100TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32608-9041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-672-1181
Provider Business Mailing Address Fax Number:
352-559-2363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4040 NEWBERRY RD STE 1500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32607-2393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-672-1181
Provider Business Practice Location Address Fax Number:
352-559-2363
Provider Enumeration Date:
01/24/2014

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: 171100000X , with the licence number:  AP 3373 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102822900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".