Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | CA |
NPI | 1003110701 |
---|---|
Provider Name | Alexander Cariaga |
First Address | West Covina, CA 91792 |
Second Address | West Covina, CA 91792 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2011 |
Last Update Date | 10/01/2011 |