Healthcare Provider Details

I. General information

NPI: 1003483025
Provider Name (Legal Business Name): AMP SPORTS MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 W GARVEY AVE N
WEST COVINA CA
91790-2005
US

IV. Provider business mailing address

1705 W GARVEY AVE N
WEST COVINA CA
91790-2005
US

V. Phone/Fax

Practice location:
  • Phone: 949-264-6440
  • Fax:
Mailing address:
  • Phone: 949-264-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JACINTO M FLORES-ALVAREZ
Title or Position: OWNER
Credential: DC
Phone: 949-264-6440