Provider Demographics
NPI:1437547965
Name:ALBERTO, ALEXIS
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:ALBERTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W CHESTNUT ST
Mailing Address - Street 2:APT. 304
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1762
Mailing Address - Country:US
Mailing Address - Phone:213-361-2757
Mailing Address - Fax:
Practice Address - Street 1:200 W CHESTNUT ST
Practice Address - Street 2:APT. 304
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1762
Practice Address - Country:US
Practice Address - Phone:213-361-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist