Provider Demographics
NPI:1649394099
Name:SMALL, ALEJANDRO DOMINGO (OTRL)
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:DOMINGO
Last Name:SMALL
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-4011
Mailing Address - Country:US
Mailing Address - Phone:909-374-0001
Mailing Address - Fax:
Practice Address - Street 1:6200 OREGON AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1543
Practice Address - Country:US
Practice Address - Phone:202-541-0403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05746225X00000X
DCOT010000400225X00000X
CAOT4122225X00000X
VA0119004495225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist