Provider Demographics
NPI:1124170774
Name:ALVARADO, ELVIN (MD)
Entity type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:
Last Name:ALVARADO
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 1:429 CALLE FLAMBOYAN
Mailing Address - Street 2:URB. LOS SAUCES
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4910
Mailing Address - Country:US
Mailing Address - Phone:787-630-4263
Mailing Address - Fax:
Practice Address - Street 1:41 CALLE CRISTOBAL COLON
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-3324
Practice Address - Country:US
Practice Address - Phone:787-266-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9492208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7180014OtherHUMANA
PR1897OtherIMC
PR2011029OtherUTI
PR2731OtherPMC
PR31-09492OtherUIA
PR81687Medicare ID - Type Unspecified