Provider Demographics
NPI:1861094294
Name:ALICNA, RANDY NAVARRO (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:NAVARRO
Last Name:ALICNA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 GARNET ST APT 229
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-3327
Mailing Address - Country:US
Mailing Address - Phone:415-299-4543
Mailing Address - Fax:
Practice Address - Street 1:774 S PLACENTIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6838
Practice Address - Country:US
Practice Address - Phone:415-299-4543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT293751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist