Healthcare Provider Details

I. General information

NPI: 1114857034
Provider Name (Legal Business Name): SCOTT ALVES PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16305 HARBOR BLVD
FOUNTAIN VALLEY CA
92708-1311
US

IV. Provider business mailing address

16305 HARBOR BLVD
FOUNTAIN VALLEY CA
92708-1311
US

V. Phone/Fax

Practice location:
  • Phone: 657-204-2959
  • Fax:
Mailing address:
  • Phone: 657-204-2959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number52366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: