Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053734962 |
---|---|
Provider Name | Jeffrey Alvarado |
First Address | Pasadena, CA 91107-3464 |
Second Address | Los Angeles, CA 90033-2739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2014 |
Last Update Date | 28/02/2014 |