Healthcare Provider Details

I. General information

NPI: 1982334900
Provider Name (Legal Business Name): ALEX IGNACIO ALBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date: 06/23/2024
Reactivation Date: 03/18/2025

III. Provider practice location address

131 MAPLES PARK
WEST LAFAYETTE IN
47906-5370
US

IV. Provider business mailing address

131 MAPLES PARK
WEST LAFAYETTE IN
47906-5370
US

V. Phone/Fax

Practice location:
  • Phone: 765-430-3435
  • Fax:
Mailing address:
  • Phone: 765-430-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: