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General NPI Number Information
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NPI Number | 1881421113
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Entity Type | Organization
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Legal Business Name | FENTON ADOS TESTING INC.
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 212 W SILVER LAKE RD
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City | FENTON
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State | MI
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Zip | 48430-2606
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Country | US
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Telephone | 810-629-3070
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Fax |
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Provider Business Mailing Address
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Address Line | 212 W SILVER LAKE RD
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City | FENTON
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State | MI
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Zip | 48430-2606
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Country | US
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Telephone | 810-629-3070
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. JUAN ALVARADO
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Credential | O.D.
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Telephone | 810-629-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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Taxonomy #3
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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Taxonomy #4
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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