Healthcare Provider Details

I. General information

NPI: 1285597112
Provider Name (Legal Business Name): ALVEZ HEREDIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 11/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIRCLE TRAVIS AFB
FAIRFIELD CA
94535-1809
US

IV. Provider business mailing address

825 ARNOLD DR STE 9
MARTINEZ CA
94553-6837
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: