Provider Demographics
NPI:1619649647
Name:ALCANTAR, USIEL
Entity Type:Individual
Prefix:
First Name:USIEL
Middle Name:
Last Name:ALCANTAR
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 1:145 N N ST STE A
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-4249
Mailing Address - Country:US
Mailing Address - Phone:559-687-8713
Mailing Address - Fax:844-368-4079
Practice Address - Street 1:145 N N ST STE A
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4249
Practice Address - Country:US
Practice Address - Phone:559-687-8713
Practice Address - Fax:844-368-4079
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator