Healthcare Provider Details

I. General information

NPI: 1174292858
Provider Name (Legal Business Name): ALVS HONRADO MONDARES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7862 EL CAJON BLVD
LA MESA CA
91942-6712
US

IV. Provider business mailing address

2920 BRIARWOOD RD UNIT I4
BONITA CA
91902-1836
US

V. Phone/Fax

Practice location:
  • Phone: 619-697-3093
  • Fax:
Mailing address:
  • Phone: 619-208-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number300965
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: