Provider Demographics
NPI:1942709373
Name:ARVIZU, OMAR ALVAREZ (PT, DPT)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:ALVAREZ
Last Name:ARVIZU
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:OMAR
Other - Middle Name:ALBERTO
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1761 LARKHAVEN GLN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-1083
Mailing Address - Country:US
Mailing Address - Phone:760-807-5211
Mailing Address - Fax:
Practice Address - Street 1:577 E ELDER ST STE I
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3079
Practice Address - Country:US
Practice Address - Phone:760-723-2687
Practice Address - Fax:760-723-2689
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist