Provider Demographics
NPI:1285122028
Name:ALVAREZ, WILBERT-JOHN (NMD)
Entity type:Individual
Prefix:DR
First Name:WILBERT-JOHN
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 E VAN BUREN ST UNIT 377
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7963
Mailing Address - Country:US
Mailing Address - Phone:847-312-8819
Mailing Address - Fax:
Practice Address - Street 1:5345 E VAN BUREN ST UNIT 377
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7963
Practice Address - Country:US
Practice Address - Phone:847-312-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1707175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty