Healthcare Provider Details

I. General information

NPI: 1801355771
Provider Name (Legal Business Name): ALEXANDER MASTROVITO OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 05/14/2023
Certification Date: 05/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W 213TH ST STE 100
TORRANCE CA
90501-2852
US

IV. Provider business mailing address

1815 W 213TH ST STE 100
TORRANCE CA
90501-2852
US

V. Phone/Fax

Practice location:
  • Phone: 310-328-0276
  • Fax: 310-328-7058
Mailing address:
  • Phone: 310-328-0276
  • Fax: 310-328-7058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number23969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: