Healthcare Provider Details

I. General information

NPI: 1922371129
Provider Name (Legal Business Name): DERRIEL ALEXIS ALMARIO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23456 HAWTHORNE BLVD SUITE 300
TORRANCE CA
90505-4716
US

IV. Provider business mailing address

3206 CEDAR AVE
LONG BEACH CA
90806-1222
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-6190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT9551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: