Provider Demographics
NPI:1871074070
Name:ARIAS, ALEXANDER (COTA/L)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:ARIAS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 GROSVENOR BLVD APT 259
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7315
Mailing Address - Country:US
Mailing Address - Phone:305-343-1211
Mailing Address - Fax:
Practice Address - Street 1:6835 HAZELTINE AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3218
Practice Address - Country:US
Practice Address - Phone:818-997-1841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2982224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2982OtherCA BOARD OF OCCUPATIONAL THERAPY