Provider Demographics
NPI:1053379115
Name:ALVAREZ, JAIME
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9075 SW 87TH AVE STE 414
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2308
Mailing Address - Country:US
Mailing Address - Phone:305-273-5060
Mailing Address - Fax:305-274-0003
Practice Address - Street 1:9075 SW 87TH AVE STE 414
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-273-5060
Practice Address - Fax:305-274-0003
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55208207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377617401Medicaid
FLME55208OtherSTATE LICENSE
FLEB554AMedicare PIN
FL11789ZMedicare PIN
FLE80651Medicare UPIN