Provider Demographics
NPI:1740079078
Name:UBALDE, ALDWIN JOHNDALE VELASQUEZ
Entity type:Individual
Prefix:
First Name:ALDWIN JOHNDALE
Middle Name:VELASQUEZ
Last Name:UBALDE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 JAMES M WOOD BLVD APT 106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1755
Mailing Address - Country:US
Mailing Address - Phone:818-319-2964
Mailing Address - Fax:
Practice Address - Street 1:74 N PASADENA AVE FL 6
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3600
Practice Address - Country:US
Practice Address - Phone:626-381-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51361225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant