Basic Information
Provider Information
NPI: 1477681807
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FORERO
FirstName: ALVARO
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 840207
Address2:  
City: PEMBROKE PINES
State: FL
PostalCode: 330842207
CountryCode: US
TelephoneNumber: 3055954510
FaxNumber:  
Practice Location
Address1: 9370 SUNSET DRIVE
Address2: # A-250
City: MIAMI
State: FL
PostalCode: 33173
CountryCode: US
TelephoneNumber: 3055954510
FaxNumber: 3055959465
Other Information
ProviderEnumerationDate: 02/28/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN2212902FLY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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