Healthcare Provider Details

I. General information

NPI: 1215547252
Provider Name (Legal Business Name): DR. ANTHONY ALVIDREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 E SAN ANTONIO DR STE A
LONG BEACH CA
90807-2379
US

IV. Provider business mailing address

14307 SYRACUSE DR
WHITTIER CA
90604-2935
US

V. Phone/Fax

Practice location:
  • Phone: 562-355-8993
  • Fax:
Mailing address:
  • Phone: 562-355-8993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: