Healthcare Provider Details

I. General information

NPI: 1538353289
Provider Name (Legal Business Name): ALLIANCE FIDELEITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E HARVARD ST SUITE 202
GLENDALE CA
91205-1057
US

IV. Provider business mailing address

415 E HARVARD ST SUITE 202
GLENDALE CA
91205-1057
US

V. Phone/Fax

Practice location:
  • Phone: 818-247-5808
  • Fax: 818-500-8075
Mailing address:
  • Phone: 818-247-5808
  • Fax: 818-500-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number550000929
License Number StateCA

VIII. Authorized Official

Name: BABAK KAMKAR
Title or Position: CEO
Credential:
Phone: 818-247-5808