Basic Information
Provider Information
NPI: 1316379118
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SALVADOR
FirstName: ALANN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTD/OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4211 AVALON BLVD
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900115622
CountryCode: US
TelephoneNumber: 3234325185
FaxNumber: 3234325086
Practice Location
Address1: 4211 AVALON BLVD
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900115622
CountryCode: US
TelephoneNumber: 3234325086
FaxNumber: 3234325086
Other Information
ProviderEnumerationDate: 08/02/2013
LastUpdateDate: 08/02/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XM0800X11529CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health

No ID Information.


Home