Provider Demographics
NPI:1487103784
Name:ALLIANCE MEDICAL GROUP
Entity type:Organization
Organization Name:ALLIANCE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-746-6530
Mailing Address - Street 1:PO BOX 390005
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92149-0005
Mailing Address - Country:US
Mailing Address - Phone:619-512-6200
Mailing Address - Fax:
Practice Address - Street 1:2323 E 8TH ST STE 103
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2813
Practice Address - Country:US
Practice Address - Phone:619-512-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107847207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty