Healthcare Provider Details

I. General information

NPI: 1306043161
Provider Name (Legal Business Name): ALIREZA HOVEYDA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12110 SMALLWOOD AVE
DOWNEY CA
90242-2331
US

IV. Provider business mailing address

12110 SMALLWOOD AVE
DOWNEY CA
90242-2331
US

V. Phone/Fax

Practice location:
  • Phone: 562-861-5349
  • Fax: 562-862-4045
Mailing address:
  • Phone: 562-861-5349
  • Fax: 562-862-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 24840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: