Provider Demographics
NPI:1558504480
Name:CAMINO, ALVIE (OT)
Entity Type:Individual
Prefix:
First Name:ALVIE
Middle Name:
Last Name:CAMINO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5359 TRENTO WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4611
Mailing Address - Country:US
Mailing Address - Phone:909-528-0776
Mailing Address - Fax:909-822-7863
Practice Address - Street 1:16689 FOOTHILL BLVD STE 106
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8410
Practice Address - Country:US
Practice Address - Phone:909-528-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 9783225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation