Provider Demographics
NPI:1194078378
Name:ILAGAN, ALFREDO ZARA JR (PT)
Entity type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:ZARA
Last Name:ILAGAN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 MARTIN LUTHER KING JR AVE APT B
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-5862
Mailing Address - Country:US
Mailing Address - Phone:626-272-7220
Mailing Address - Fax:
Practice Address - Street 1:1132 MARTIN LUTHER KING JR AVE APT B
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-5862
Practice Address - Country:US
Practice Address - Phone:626-272-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist