Healthcare Provider Details

I. General information

NPI: 1497264394
Provider Name (Legal Business Name): ALVARO ESTURADO CUELLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 NORDHOFF ST
NORTHRIDGE CA
91330-0001
US

IV. Provider business mailing address

7747 CASE AVE
SUN VALLEY CA
91352-4436
US

V. Phone/Fax

Practice location:
  • Phone: 818-677-1200
  • Fax:
Mailing address:
  • Phone: 818-804-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: