Healthcare Provider Details

I. General information

NPI: 1720675986
Provider Name (Legal Business Name): HEALTH SERVICE ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S INDIAN HILL BLVD STE F
CLAREMONT CA
91711-4929
US

IV. Provider business mailing address

220 S INDIAN HILL BLVD STE F
CLAREMONT CA
91711-4929
US

V. Phone/Fax

Practice location:
  • Phone: 909-281-5800
  • Fax:
Mailing address:
  • Phone: 909-281-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY J COX
Title or Position: CFO
Credential:
Phone: 909-464-9675