Manuel De Alba, MAT, ATC, CES

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2000009968

Practice address

1123 Coleman Ave
San Jose, CA 95110-1104

Phone

(408) 556-7761

NPI assigned

Jan 26, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1639569841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3506 21ST ST",
            "address_2": "SUITE 202",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1123 COLEMAN AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951101104",
            "telephone_number": "408-556-7761"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5601 19th St",
            "address_purpose": "LOCATION",
            "city": "Lubbock",
            "state": "TX",
            "postal_code": "794072031",
            "country_code": "US",
            "telephone_number": "209-479-4866",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE ALBA",
        "first_name": "MANUEL",
        "name_prefix": "Mr.",
        "credential": "MAT, ATC, CES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-26",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT5737",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": "2000009968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Eramelisse De Castro
• Sebastien Marie Gerard De Feraudy, MD-PHD
• Abigail De Guzman

• Athletic Trainer in San Jose, CA
• Providers in San Jose, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.