Provider Demographics
NPI:1194051946
Name:ALLIANCE HEALTHCARE CLINIC CORP
Entity type:Organization
Organization Name:ALLIANCE HEALTHCARE CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-251-7627
Mailing Address - Street 1:4311 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7358
Mailing Address - Country:US
Mailing Address - Phone:321-251-7627
Mailing Address - Fax:321-445-6072
Practice Address - Street 1:4311 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7358
Practice Address - Country:US
Practice Address - Phone:321-251-7627
Practice Address - Fax:321-445-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health