Provider Demographics
NPI:1194867077
Name:TENORIO, LUIS ALONZO (AA DEGREE PTA)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALONZO
Last Name:TENORIO
Suffix:
Gender:M
Credentials:AA DEGREE PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11819 NAVA ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-6521
Mailing Address - Country:US
Mailing Address - Phone:562-864-6420
Mailing Address - Fax:
Practice Address - Street 1:11819 NAVA ST.
Practice Address - Street 2:2499 S. WILMINGTON AVE.
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220
Practice Address - Country:US
Practice Address - Phone:310-638-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 6875261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy