Healthcare Provider Details

I. General information

NPI: 1326972076
Provider Name (Legal Business Name): MAXEMILIANO L ALCANTAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5478 WILSHIRE BLVD STE 212
LOS ANGELES CA
90036-4225
US

IV. Provider business mailing address

608 S DUNSMUIR AVE APT 208
LOS ANGELES CA
90036-5916
US

V. Phone/Fax

Practice location:
  • Phone: 323-508-3004
  • Fax:
Mailing address:
  • Phone: 559-359-2776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC37616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: