Healthcare Provider Details

I. General information

NPI: 1740079078
Provider Name (Legal Business Name): ALDWIN JOHNDALE VELASQUEZ UBALDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 N PASADENA AVE FL 6
PASADENA CA
91103-3600
US

IV. Provider business mailing address

2715 JAMES M WOOD BLVD APT 106
LOS ANGELES CA
90006-1755
US

V. Phone/Fax

Practice location:
  • Phone: 626-381-4220
  • Fax:
Mailing address:
  • Phone: 818-319-2964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: