Provider Demographics
NPI:1508293523
Name:CERDA, ALVARO (RT R CT ARRT)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:
Last Name:CERDA
Suffix:
Gender:M
Credentials:RT R CT ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W VERNON AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2700
Mailing Address - Country:US
Mailing Address - Phone:323-231-5044
Mailing Address - Fax:323-231-5362
Practice Address - Street 1:231 W VERNON AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2700
Practice Address - Country:US
Practice Address - Phone:323-231-5044
Practice Address - Fax:323-231-5362
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355148247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFC506AMedicare PIN