Healthcare Provider Details

I. General information

NPI: 1871191742
Provider Name (Legal Business Name): ALCAM MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 N MARIPOSA ST STE 10
FRESNO CA
93703-3929
US

IV. Provider business mailing address

1760 CHICAGO AVE STE L21
RIVERSIDE CA
92507-2326
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-7000
  • Fax: 951-489-0422
Mailing address:
  • Phone: 951-782-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ALPHA ISCANDARI SANUSI
Title or Position: PRESIDENT
Credential: BOCPO
Phone: 951-782-7000