Organization
ILLUMINATE PEDIATRIC THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO ANTONIO ALVARADO M.D. (OWNER / PHYSICIAN)
(210) 286-2703
Entity
Organization
Contact information
Practice address
5804 BABCOCK RD, #318, SAN ANTONIO, TX 78240-2134
(210) 286-2703
Mailing address
5804 BABCOCK RD, #318, SAN ANTONIO, TX 78240-2134
(210) 286-2703
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
110160
TX
Other
Enumeration date
09/03/2010
Last updated
09/03/2010
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