Healthcare Provider Details

I. General information

NPI: 1912182684
Provider Name (Legal Business Name): ALFA ALLIED MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E WASHINGTON BLVD
LOS ANGELES CA
90021-3020
US

IV. Provider business mailing address

1005 E WASHINGTON BLVD
LOS ANGELES CA
90021-3020
US

V. Phone/Fax

Practice location:
  • Phone: 213-745-3636
  • Fax: 213-745-3626
Mailing address:
  • Phone: 213-745-3636
  • Fax: 213-745-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76158
License Number StateCA

VIII. Authorized Official

Name: DR. HECTOR CASTILLO
Title or Position: PRESIDENT
Credential: M.D
Phone: 213-745-3636