Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME63461 | FL |
NPI | 1003841826 |
---|---|
Provider Name | Dr. Sandra Ivelisse Alvarez |
First Address | Deland, FL 32720-3284 |
Second Address | Deland, FL 32720-3284 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9446 | INACTIVE PR LICENSE (01) | PR |
BA1933399 | DEA LICENSE (01) | FL |
D95214 | (02) | FL |