Provider Demographics
NPI:1902268501
Name:ALPHA MEDICAL CENTRE WALTERS, LTD
Entity type:Organization
Organization Name:ALPHA MEDICAL CENTRE WALTERS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-540-3499
Mailing Address - Street 1:348 N NELLIS BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-0053
Mailing Address - Country:US
Mailing Address - Phone:702-570-5072
Mailing Address - Fax:702-570-5384
Practice Address - Street 1:348 N NELLIS BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-0053
Practice Address - Country:US
Practice Address - Phone:702-570-5072
Practice Address - Fax:702-570-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4017261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care