Provider Demographics
NPI:1528464153
Name:ALVIDREZ, FERNANDO (ATC)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:ALVIDREZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 N 83RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5945
Mailing Address - Country:US
Mailing Address - Phone:623-486-6301
Mailing Address - Fax:623-486-6330
Practice Address - Street 1:11200 N 83RD AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-5945
Practice Address - Country:US
Practice Address - Phone:623-486-6301
Practice Address - Fax:623-486-6330
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer