Provider Demographics
NPI:1407170962
Name:ALVINO, DENIS M (OMD,LAC)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:M
Last Name:ALVINO
Suffix:
Gender:M
Credentials:OMD,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FREMONT AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3225
Mailing Address - Country:US
Mailing Address - Phone:626-441-1988
Mailing Address - Fax:
Practice Address - Street 1:1000 FREMONT AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3225
Practice Address - Country:US
Practice Address - Phone:626-441-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 2844171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist