Provider Demographics
NPI:1699798132
Name:ALVAREZ-HERNANDEZ, JACQUELINE (PT)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:ALVAREZ-HERNANDEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OF18 CALLE 505
Mailing Address - Street 2:URB. COUNTRY CLUB
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-1809
Mailing Address - Country:US
Mailing Address - Phone:787-768-2383
Mailing Address - Fax:787-768-2383
Practice Address - Street 1:OF18 CALLE 505
Practice Address - Street 2:URB. COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-1809
Practice Address - Country:US
Practice Address - Phone:787-768-2383
Practice Address - Fax:787-768-2383
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0056846Medicare UPIN