Healthcare Provider Details

I. General information

NPI: 1255244059
Provider Name (Legal Business Name): JONATHAN ALCANTARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E HARDY ST
INGLEWOOD CA
90301-4011
US

IV. Provider business mailing address

12703 ALCHESTER ST
CERRITOS CA
90703-7271
US

V. Phone/Fax

Practice location:
  • Phone: 310-673-4660
  • Fax:
Mailing address:
  • Phone: 562-884-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: