Healthcare Provider Details

I. General information

NPI: 1447601489
Provider Name (Legal Business Name): ALLERGY TESTING GROUP OF CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13966 VALLEY VIEW AVE
LA MIRADA CA
90638-3503
US

IV. Provider business mailing address

13966 VALLEY VIEW AVE
LA MIRADA CA
90638-3503
US

V. Phone/Fax

Practice location:
  • Phone: 844-865-5677
  • Fax:
Mailing address:
  • Phone: 844-865-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number87291
License Number StateCA

VIII. Authorized Official

Name: VANESSA ALVAREZ
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 844-865-5677