Provider Demographics
NPI:1568456473
Name:ALVARADO, ANDRES (MD)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2794 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6080
Mailing Address - Country:US
Mailing Address - Phone:928-846-7097
Mailing Address - Fax:866-703-1213
Practice Address - Street 1:1840 MESQUITE AVE STE B
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5771
Practice Address - Country:US
Practice Address - Phone:928-846-7097
Practice Address - Fax:866-703-1213
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26109207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG71877Medicare UPIN
AZ67695Medicare PIN