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Individual
MARIO ERNESTO HENRIQUEZ ALVARENGA
Active
Individual
MARIO ERNESTO HENRIQUEZ ALVARENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD20160227
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972941813
BCBS
NM
05
—
1972941813
—
NM
01
—
1K8582
MEDICARE
NM
Enumeration date
06/13/2013
Last updated
04/27/2021
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