Basic Information
| Provider Information | |||||||||
| NPI: | 1255773313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALVAREZ | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 TRANS MOUNTAIN RD STE B | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799113602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152158400 | ||||||||
| FaxNumber: | 9156129253 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000B TRANS MOUNTAIN ROAD | ||||||||
| Address2: | OPHTHALMOLOGY CLINIC 3RD FLOOR | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799113600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152158400 | ||||||||
| FaxNumber: | 9156129253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2013 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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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 | 207WX0107X | R7160 | TX | N | 207W00000X | R7160 | TX | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 0230957 | 05 | OH | MEDICAID |