Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1114245768 |
---|---|
Provider Name | Mr. Alfonso Alvarez |
First Address | Edmond, OK 73013-9437 |
Second Address | Oklahoma City, OK 73105-1811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2010 |
Last Update Date | 06/05/2010 |