1427057140 NPI number — REBECCA ALVAREZ PA-C

Table of content: REBECCA ALVAREZ PA-C (NPI 1427057140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427057140 NPI number — REBECCA ALVAREZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALVAREZ
Provider First Name:
REBECCA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1427057140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 E WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85034-1052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-340-1429
Provider Business Mailing Address Fax Number:
602-340-1327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1847 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-5881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-897-1122
Provider Business Practice Location Address Fax Number:
480-237-1213
Provider Enumeration Date:
07/14/2005

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: 363AM0700X , with the licence number:  2770 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 764101 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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