Provider Demographics
NPI:1588308472
Name:CARRION, ALFREDO I (CMT)
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:I
Last Name:CARRION
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19067 PARADISE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-7505
Mailing Address - Country:US
Mailing Address - Phone:760-666-0213
Mailing Address - Fax:
Practice Address - Street 1:28714 VALLEY CENTER RD
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-6554
Practice Address - Country:US
Practice Address - Phone:760-666-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89385225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist