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General NPI Number Information
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NPI Number | 1235446832
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Entity Type | Organization
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Legal Business Name | ILLUMINATE PEDIATRIC THERAPY, PLLC
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 5804 BABCOCK RD #318
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City | SAN ANTONIO
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State | TX
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Zip | 78240-2134
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Country | US
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Telephone | 210-286-2703
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Fax |
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Provider Business Mailing Address
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Address Line | 5804 BABCOCK RD #318
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City | SAN ANTONIO
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State | TX
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Zip | 78240-2134
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Country | US
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Telephone | 210-286-2703
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Fax |
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Authorized Official
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Title or Position | OWNER / PHYSICIAN
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Name | RICARDO ANTONIO ALVARADO
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Credential | M.D.
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Telephone | 210-286-2703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 110160
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License Number State | TX
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