Healthcare Provider Details

I. General information

NPI: 1396652392
Provider Name (Legal Business Name): DAVID OSVALDO ALVARENGA MASSAGE THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8244 DE SOTO AVE
CANOGA PARK CA
91304-4342
US

IV. Provider business mailing address

17111 ROSCOE BLVD UNIT 14
NORTHRIDGE CA
91325-4070
US

V. Phone/Fax

Practice location:
  • Phone: 818-418-7488
  • Fax:
Mailing address:
  • Phone: 818-497-3836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number98509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: