Healthcare Provider Details

I. General information

NPI: 1851202204
Provider Name (Legal Business Name): RAMON CRUZ ALVAREZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 S HAM LN STE B
LODI CA
95242-3532
US

IV. Provider business mailing address

631 S HAM LN STE B
LODI CA
95242-3532
US

V. Phone/Fax

Practice location:
  • Phone: 209-368-7433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: