Provider Demographics
NPI:1154770378
Name:SANTANA ALVAREZ, DAMARYS
Entity type:Individual
Prefix:
First Name:DAMARYS
Middle Name:
Last Name:SANTANA ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4293 W 7TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3826
Mailing Address - Country:US
Mailing Address - Phone:305-684-7898
Mailing Address - Fax:
Practice Address - Street 1:11401 SW 40TH ST STE 313
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3339
Practice Address - Country:US
Practice Address - Phone:786-452-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017765000Medicaid