Healthcare Provider Details

I. General information

NPI: 1710458245
Provider Name (Legal Business Name): ENLIGHTENED HEALTHCARE ALLIANCE MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 ENCINITAS BLVD STE 220
ENCINITAS CA
92024-6791
US

IV. Provider business mailing address

PO BOX 231366
ENCINITAS CA
92023-1366
US

V. Phone/Fax

Practice location:
  • Phone: 833-446-6363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXIE KHANH NGUYEN
Title or Position: PRESIDENT
Credential: MD
Phone: 833-466-6363