Healthcare Provider Details

I. General information

NPI: 1992254650
Provider Name (Legal Business Name): ALLOY HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date: ALLOY HEALTH GROUP 1108 E PALMER AVE GLENDALE CA 91205 1108 E PALMER AVE GLENDALE CA 91205
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 E PALMER AVE STE 19
GLENDALE CA
91205-2578
US

IV. Provider business mailing address

1108 E PALMER AVE STE 19
GLENDALE CA
91205-2578
US

V. Phone/Fax

Practice location:
  • Phone: 818-209-1919
  • Fax: 844-273-4456
Mailing address:
  • Phone: 818-209-1919
  • Fax: 844-273-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health
License Number
License Number State

VIII. Authorized Official

Name: MAROUT MARY ANTONIAN
Title or Position: CEO
Credential:
Phone: 818-209-1919