Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125070570 | IL |
N | 111NI0900X | Internist | 125070570 | IL |
Y | 207RI0200X | Infectious Disease | 036152562 | IL |
NPI | 1063948495 |
---|---|
Provider Name | Raisa Gabriela Alvarez |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153-3328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2017 |
Last Update Date | 24/06/2020 |