Healthcare Provider Details

I. General information

NPI: 1174550024
Provider Name (Legal Business Name): ALLIANCE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 PARK ST SUITE 202
ALAMEDA CA
94501-4545
US

IV. Provider business mailing address

1332 PARK ST SUITE 202
ALAMEDA CA
94501-4545
US

V. Phone/Fax

Practice location:
  • Phone: 510-523-3417
  • Fax: 916-239-3614
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD M. SANKARY
Title or Position: PRESIDENT
Credential: MD
Phone: 510-724-9110