Provider Demographics
NPI:1225866098
Name:ALVAREZ, SANDRO MATEO (LMT)
Entity type:Individual
Prefix:
First Name:SANDRO
Middle Name:MATEO
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 SE 32ND PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5015
Mailing Address - Country:US
Mailing Address - Phone:971-227-8374
Mailing Address - Fax:
Practice Address - Street 1:11786 NW CEDAR FALLS DR STE 220
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-2787
Practice Address - Country:US
Practice Address - Phone:503-530-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24926225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty