Provider Demographics
NPI:1285343699
Name:ALO MEDICAL LLC
Entity type:Organization
Organization Name:ALO MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIVERA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-589-9661
Mailing Address - Street 1:1101 S EUSTIS ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-5558
Mailing Address - Country:US
Mailing Address - Phone:352-589-9661
Mailing Address - Fax:352-589-5983
Practice Address - Street 1:1101 S EUSTIS ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-5558
Practice Address - Country:US
Practice Address - Phone:352-589-9661
Practice Address - Fax:352-589-5983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME117748OtherFLORIDA MEDICAL LICENSE NUMBER