Provider Demographics
NPI:1518786128
Name:ALVAREZ SANTOS, ISMARY
Entity type:Individual
Prefix:
First Name:ISMARY
Middle Name:
Last Name:ALVAREZ SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17730 NW 67TH AVE APT 516
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5809
Mailing Address - Country:US
Mailing Address - Phone:786-835-2630
Mailing Address - Fax:
Practice Address - Street 1:17730 NW 67TH AVE APT 516
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5809
Practice Address - Country:US
Practice Address - Phone:786-835-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-383076106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician