Healthcare Provider Details

I. General information

NPI: 1255736443
Provider Name (Legal Business Name): ALEGRIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 C N PERRY RD
CALEXICO CA
92231-9723
US

IV. Provider business mailing address

1101 C N PERRY RD
CALEXICO CA
92231-9723
US

V. Phone/Fax

Practice location:
  • Phone: 760-768-8419
  • Fax: 760-768-8491
Mailing address:
  • Phone: 760-768-8419
  • Fax: 760-768-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000790
License Number StateCA

VIII. Authorized Official

Name: AIDE MUNOZ
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 760-768-8419