Provider Demographics
NPI:1689450199
Name:ALKABALAN, RODOLF
Entity Type:Individual
Prefix:
First Name:RODOLF
Middle Name:
Last Name:ALKABALAN
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 1:3071 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-0929
Mailing Address - Country:US
Mailing Address - Phone:714-783-6494
Mailing Address - Fax:
Practice Address - Street 1:3071 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-0929
Practice Address - Country:US
Practice Address - Phone:714-783-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician