Healthcare Provider Details

I. General information

NPI: 1982313821
Provider Name (Legal Business Name): ALEXIS R ALCARAZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 CANARIOS CT STE 110
CHULA VISTA CA
91910-7877
US

IV. Provider business mailing address

885 CANARIOS CT STE 110
CHULA VISTA CA
91910-7877
US

V. Phone/Fax

Practice location:
  • Phone: 619-656-5102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT299134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: