Provider Demographics
NPI:1588407217
Name:ALPHA MAN HEALTH CLINIC
Entity type:Organization
Organization Name:ALPHA MAN HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-650-8049
Mailing Address - Street 1:14044 VENTURA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3513
Mailing Address - Country:US
Mailing Address - Phone:818-650-8049
Mailing Address - Fax:818-650-8059
Practice Address - Street 1:14044 VENTURA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3513
Practice Address - Country:US
Practice Address - Phone:818-650-8049
Practice Address - Fax:818-650-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center