Provider Demographics
NPI:1629220496
Name:ALVA, TINA (DPT)
Entity type:Individual
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First Name:TINA
Middle Name:
Last Name:ALVA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:848 N KINGS RD
Mailing Address - Street 2:106
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5441
Mailing Address - Country:US
Mailing Address - Phone:310-780-1527
Mailing Address - Fax:323-655-6848
Practice Address - Street 1:1400 S GRAND AVE
Practice Address - Street 2:611
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3048
Practice Address - Country:US
Practice Address - Phone:213-745-6106
Practice Address - Fax:213-745-6107
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2016-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT20578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB250381Medicare PIN
CAW17215CMedicare PIN