Healthcare Provider Details

I. General information

NPI: 1417176207
Provider Name (Legal Business Name): ALLIANCE HEALTHCARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S GRAND AVE
GLENDORA CA
91741-4218
US

IV. Provider business mailing address

100 BAYVIEW CIR SUITE 400
NEWPORT BEACH CA
92660-2983
US

V. Phone/Fax

Practice location:
  • Phone: 626-963-8411
  • Fax:
Mailing address:
  • Phone: 800-544-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number6640-30
License Number StateCA

VIII. Authorized Official

Name: HOWARD POAN
Title or Position: EXEC VP & CFO
Credential:
Phone: 800-544-3215