Organization Active NPI

R. Michael Alvarez, DDS, Inc.

  • Dentist
  • Fremont, CA
National Provider Identifier
1093414609
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
R. MICHAEL ALVAREZ, DDS, INC.
Practice address
2188 Peralta Blvd Ste D
Fremont, CA 94536-3941
Phone
(510) 713-6790
Fax
(510) 713-6794
NPI assigned
Mar 2, 2023
Organization subpart
Yes
Parent organization
R. MICHAEL ALVAREZ, DDS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lola Nieto
Title
Office Manager
Phone
(510) 713-6790

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary
Orofacial Pain DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X2210X

Addresses

Primary practice location

2188 Peralta Blvd Ste D
Fremont, CA 94536-3941

Mailing address

2188 Peralta Blvd Ste D
Fremont, CA 94536-3941
Phone (510) 713-6790

Other identifiers 1

IdentifierTypeStateIssuer
1154461150OtherCADDS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230615001240 CA DME Supplier - Oral Surgery - Dentist 2567827694 Practice locations: Fremont, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
R Michael Alvarez DDS Inc

Locations

2188 Peralta Blvd
#D
Fremont, CA 94536
Phone (510) 713-6790

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677715200000",
    "number": "1093414609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2188 PERALTA BLVD STE D",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945363941",
            "telephone_number": "510-713-6790",
            "fax_number": "510-713-6794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2188 PERALTA BLVD STE D",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945363941",
            "telephone_number": "510-713-6790",
            "fax_number": "510-713-6794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R. MICHAEL ALVAREZ, DDS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "R. MICHAEL ALVAREZ, DDS, INC.",
        "enumeration_date": "2023-03-02",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A",
        "authorized_official_last_name": "NIETO",
        "authorized_official_first_name": "LOLA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "510-713-6790"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X2210X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orofacial Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DDS",
            "identifier": "1154461150",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.