Provider Demographics
NPI:1295766020
Name:FREIRE, ALEJANDRO JOSEPH (CP,BOCO)
Entity type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:JOSEPH
Last Name:FREIRE
Suffix:
Gender:M
Credentials:CP,BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7633 GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1626
Mailing Address - Country:US
Mailing Address - Phone:562-698-0988
Mailing Address - Fax:562-696-8791
Practice Address - Street 1:7633 GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1626
Practice Address - Country:US
Practice Address - Phone:562-698-0988
Practice Address - Fax:562-696-8791
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95-3369810222Z00000X, 224P00000X
DC222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4767OtherVENDOR FOR CCS
CAGFC00150Medicaid
CAGFC00150Medicaid