Provider Demographics
NPI:1811608128
Name:NAFARRETE, SEANALEXIS
Entity type:Individual
Prefix:DR
First Name:SEANALEXIS
Middle Name:
Last Name:NAFARRETE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SEAN ALEXIS
Other - Middle Name:
Other - Last Name:NAFARRETE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:135 VOYAGER DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4012
Mailing Address - Country:US
Mailing Address - Phone:707-315-9218
Mailing Address - Fax:
Practice Address - Street 1:5575 RUFFIN RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1361
Practice Address - Country:US
Practice Address - Phone:858-277-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist