Healthcare Provider Details

I. General information

NPI: 1851430805
Provider Name (Legal Business Name): ALTA VIEW HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 H ST STE 103
CHULA VISTA CA
91910-4779
US

IV. Provider business mailing address

296 H ST STE 103
CHULA VISTA CA
91910-4779
US

V. Phone/Fax

Practice location:
  • Phone: 619-470-4550
  • Fax: 619-470-6709
Mailing address:
  • Phone: 619-470-4550
  • Fax: 619-470-6709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number55851
License Number StateCA

VIII. Authorized Official

Name: MR. AMJAD ABDELQADER A ALQAZQI
Title or Position: MANAGING MEMBER
Credential:
Phone: 858-250-9623