Provider Demographics
NPI:1790142776
Name:ALCANTAR, ANNIE SOL
Entity Type:Individual
Prefix:
First Name:ANNIE SOL
Middle Name:
Last Name:ALCANTAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7737 MEANY AVE STE B5
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5267
Mailing Address - Country:US
Mailing Address - Phone:661-829-1150
Mailing Address - Fax:
Practice Address - Street 1:7737 MEANY AVE STE B5
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5267
Practice Address - Country:US
Practice Address - Phone:661-829-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8888225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist