Basic Information
Provider Information | |||||||||
NPI: | 1194867077 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TENORIO | ||||||||
FirstName: | LUIS | ||||||||
MiddleName: | ALONZO | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | AA DEGREE PTA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11819 NAVA ST | ||||||||
Address2: |   | ||||||||
City: | NORWALK | ||||||||
State: | CA | ||||||||
PostalCode: | 906506521 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5628646420 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 11819 NAVA ST. | ||||||||
Address2: | 2499 S. WILMINGTON AVE. | ||||||||
City: | COMPTON | ||||||||
State: | CA | ||||||||
PostalCode: | 90220 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3106381113 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/13/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | AT 6875 | CA | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.