Provider Demographics
NPI:1497802839
Name:ALVAREZ VILLALBA, CLARA LUCILA (MD)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:LUCILA
Last Name:ALVAREZ VILLALBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SE 4TH AVE STE 808A
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6497
Mailing Address - Country:US
Mailing Address - Phone:305-697-0176
Mailing Address - Fax:305-912-0574
Practice Address - Street 1:800 SE 4TH AVE STE 808A
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6497
Practice Address - Country:US
Practice Address - Phone:305-697-0176
Practice Address - Fax:305-912-0574
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2433132084P0015X
FLME1028272084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0010497-00Medicaid
FLBT919ZMedicare PIN