Provider Demographics
NPI:1992589246
Name:ALVAREZ, ISABEL VICTORIA (RD, LD)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:VICTORIA
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3826
Mailing Address - Country:US
Mailing Address - Phone:607-379-1295
Mailing Address - Fax:
Practice Address - Street 1:5650 BOLLETTIERI BLVD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2211
Practice Address - Country:US
Practice Address - Phone:800-872-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005659133V00000X
FL11267133V00000X
86119403133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered