1821238726 NPI number — DR. AIXA LYMARIE ALVAREZ MD

Table of content: DR. AIXA LYMARIE ALVAREZ MD (NPI 1821238726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821238726 NPI number — DR. AIXA LYMARIE ALVAREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALVAREZ
Provider First Name:
AIXA
Provider Middle Name:
LYMARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821238726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5804 BABCOCK RD
Provider Second Line Business Mailing Address:
166
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78240-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-366-9906
Provider Business Mailing Address Fax Number:
210-297-0731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 MCCULLOUGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78212-5601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-785-8282
Provider Business Practice Location Address Fax Number:
210-785-8288
Provider Enumeration Date:
03/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  N2374 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0064ST . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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