Basic Information
| Provider Information | |||||||||
| NPI: | 1093094641 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOVING LIVES FORWARD | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 38 DUDLEY AVE APT A | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902912405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105606243 | ||||||||
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| Practice Location | |||||||||
| Address1: | 38 DUDLEY AVE APT A | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902912405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105606243 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2011 | ||||||||
| LastUpdateDate: | 08/15/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ALVES | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | PETER | ||||||||
| AuthorizedOfficialTitleorPosition: | TRAINNEE | ||||||||
| AuthorizedOfficialTelephone: | 3105606243 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | CA | Y | Agencies | Case Management |
No ID Information.