Healthcare Provider Details

I. General information

NPI: 1558692954
Provider Name (Legal Business Name): ALVIN L ABSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALVIN LEE ABSTON E.D.D.

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 12/30/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 MISSION BLVD # 4
JURUPA VALLEY CA
92509-2970
US

IV. Provider business mailing address

8320 MISSION BLVD # 4
JURUPA VALLEY CA
92509-2970
US

V. Phone/Fax

Practice location:
  • Phone: 323-496-2202
  • Fax: 323-329-3630
Mailing address:
  • Phone: 323-496-2202
  • Fax: 323-329-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: