Provider Demographics
NPI:1053625392
Name:ADIARTE, ALEXIS NOEL (DPT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NOEL
Last Name:ADIARTE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:BATEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6131
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:277 RANCHEROS DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2976
Practice Address - Country:US
Practice Address - Phone:760-752-1011
Practice Address - Fax:760-752-1311
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA114923Medicare PIN
CACA114924Medicare PIN
CACA114925Medicare PIN
CACB205516Medicare PIN
CACA114926Medicare PIN
CACA114927Medicare PIN