Basic Information
| Provider Information | |||||||||
| NPI: | 1073632634 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALVARADO-AHUMADA | ||||||||
| FirstName: | SALESIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2230 SW 19TH AVENUE RD | ||||||||
| Address2: | BUILDING # 200 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344711391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522374133 | ||||||||
| FaxNumber: | 3522377728 | ||||||||
| Practice Location | |||||||||
| Address1: | 2230 SW 19TH AVENUE RD | ||||||||
| Address2: | BUILDING # 200 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344711391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522374133 | ||||||||
| FaxNumber: | 3522377728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 06/10/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME96717 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 279954500 | 05 | FL | MEDICAID |