Individual
ROXANA ALVAREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4112 GAGE AVE, LYONS, IL 60534-1408
(773) 767-2225
Mailing address
4112 GAGE AVE, LYONS, IL 60534-1408
(773) 767-2225
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
227004508
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-8510997
GROUP TAX ID
IL
Enumeration date
08/21/2014
Last updated
08/21/2014
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