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General NPI Number Information
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NPI Number | 1144918210
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Entity Type | Individual
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Provider Name | CARLO RIEL DE LEON ALCALA OTR
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Gender | Male
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 2230 W SUNNYSIDE AVE STE 1
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City | VISALIA
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State | CA
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Zip | 93277-7269
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Country | US
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Telephone | 559-799-7209
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 W GRAND AVE APT 212
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City | PORTERVILLE
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State | CA
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Zip | 93257-1978
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Country | US
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Telephone | 559-339-5776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT16000
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License Number State | CA
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