Provider Demographics
NPI:1891321915
Name:DAVID ALVARADO, EDNA
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:DAVID ALVARADO
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:HC 4 BOX 5862
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9674
Mailing Address - Country:US
Mailing Address - Phone:787-205-7268
Mailing Address - Fax:
Practice Address - Street 1:PASEOS DE JACARANDA
Practice Address - Street 2:G67 MAGA
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-9629
Practice Address - Country:US
Practice Address - Phone:787-205-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR149821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4563647OtherDRIVERS LICENSE