Healthcare Provider Details

I. General information

NPI: 1215265558
Provider Name (Legal Business Name): JOAQUIN ALFARO BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E ROUTE 66
GLENDORA CA
91740-4659
US

IV. Provider business mailing address

2200 E ROUTE 66 SUITE 100
GLENDORA CA
91740-4659
US

V. Phone/Fax

Practice location:
  • Phone: 626-859-2089
  • Fax:
Mailing address:
  • Phone: 626-859-2089
  • Fax: 626-859-6537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: