Provider Demographics
NPI:1063070902
Name:ALVAREZ, RAFAEL F (MD)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:F
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4360
Mailing Address - Country:US
Mailing Address - Phone:786-481-5909
Mailing Address - Fax:786-481-5908
Practice Address - Street 1:151 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4360
Practice Address - Country:US
Practice Address - Phone:786-481-5909
Practice Address - Fax:786-481-5908
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020640400Medicaid