MEDICARE: MR. MANUEL LAZARO ALVAREZ JR. OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT 6558	CA

General Provider Information

NPI Number	:	1689874422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MANUEL LAZARO ALVAREZ JR. OTR/L

Provider Business Mailing Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2354
Country	:	US
Telephone Number	:	310-936-2226
Fax Number	:	310-745-0842

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2354
Country	:	US
Telephone Number	:	310-936-2226
Fax Number	:	310-745-0842

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	07/19/2007

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