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General NPI Number Information
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NPI Number | 1487786059
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Entity Type | Individual
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Provider Name | MR. LAMAR ANTHONY ALDRIDGE
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Gender | Male
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 1411 N GRAND AVE SUITE 100
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City | COVINA
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State | CA
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Zip | 91724-1001
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Country | US
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Telephone | 626-395-7100
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Fax | 626-974-8114
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Provider Business Mailing Address
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Address Line | 3383 N D ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92405-2415
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Country | US
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Telephone | 909-883-0640
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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