Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | S0255 | TX |
N | 207R00000X | Internist | 5706 | OK |
N | 111NI0900X | Internist | 5706 | OK |
NPI | 1417377839 |
---|---|
Provider Name | Sasha Ahangama Alvarado |
First Address | Murphy, TX 75094-4587 |
Second Address | Murphy, TX 75094-4587 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2014 |
Last Update Date | 26/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S0255 | STATE LICENSE (01) | TX |