Healthcare Provider Details

I. General information

NPI: 1831173129
Provider Name (Legal Business Name): JOSE DE JESUS ALVAREZ PT, DPT,OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSE D. ALVAREZ

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 AVOCADO AVE SUITE 107
PERRIS CA
92571-2605
US

IV. Provider business mailing address

24630 WASHINGTON AVE SUITE 200
MURRIETA CA
92562-6177
US

V. Phone/Fax

Practice location:
  • Phone: 951-943-8105
  • Fax: 951-943-8106
Mailing address:
  • Phone: 951-696-9353
  • Fax: 951-973-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: