Healthcare Provider Details

I. General information

NPI: 1194346627
Provider Name (Legal Business Name): ALERRA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31959 10TH AVE # A
LAGUNA BEACH CA
92651-6838
US

IV. Provider business mailing address

31959 10TH AVE # A
LAGUNA BEACH CA
92651-6838
US

V. Phone/Fax

Practice location:
  • Phone: 800-558-0312
  • Fax: 949-281-7707
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MARTIN CANALES
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 949-258-9883