Provider Demographics
NPI:1487826723
Name:ALIDIO, AIDEN XIAN HERNANDEZ (DPT)
Entity type:Individual
Prefix:MR
First Name:AIDEN XIAN
Middle Name:HERNANDEZ
Last Name:ALIDIO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 POMEROY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1329
Mailing Address - Country:US
Mailing Address - Phone:201-370-8802
Mailing Address - Fax:
Practice Address - Street 1:1818 POMEROY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1329
Practice Address - Country:US
Practice Address - Phone:201-370-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014804225100000X
CA294209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist