Basic Information
| Provider Information | |||||||||
| NPI: | 1841424181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALVARADO | ||||||||
| FirstName: | SERGIO | ||||||||
| MiddleName: | ANTONIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1729 WESTON BRENT LN STE A | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799353013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152569751 | ||||||||
| FaxNumber: | 9159742344 | ||||||||
| Practice Location | |||||||||
| Address1: | 2267 TRAWOOD DR STE G2 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799353027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152569751 | ||||||||
| FaxNumber: | 9159742344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2009 | ||||||||
| LastUpdateDate: | 09/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | P7738 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 331389201 | 05 | TX | MEDICAID | 331587YMUW | 01 | TX | MEDICARE | OTHER |