1235479528 NPI number — MR. KIRL JUDE EULLARAN ALVIOLA PT

Table of content: (NPI 1770096174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235479528 NPI number — MR. KIRL JUDE EULLARAN ALVIOLA PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALVIOLA
Provider First Name:
KIRL
Provider Middle Name:
JUDE EULLARAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235479528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14670 MEADOWSWEET DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92880-9145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-345-0584
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92882-5941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-736-4700
Provider Business Practice Location Address Fax Number:
951-340-2831
Provider Enumeration Date:
02/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  38075 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 38075 . This is a "PHYSICAL THERAPY BOARD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com