Provider Demographics
NPI:1912540477
Name:ALCID, CHRIS ALAN
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:ALAN
Last Name:ALCID
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 1:16136 HUCKLEBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-8884
Mailing Address - Country:US
Mailing Address - Phone:909-573-7560
Mailing Address - Fax:
Practice Address - Street 1:2151 E CONVENTION CENTER WAY
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5429
Practice Address - Country:US
Practice Address - Phone:909-259-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service