Provider Demographics
NPI:1033510094
Name:ALVAREZ, ALEX (PTA)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5218 KARLING PL
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-4572
Mailing Address - Country:US
Mailing Address - Phone:323-828-0643
Mailing Address - Fax:
Practice Address - Street 1:5218 KARLING PL
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4572
Practice Address - Country:US
Practice Address - Phone:323-828-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT10373225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant