Healthcare Provider Details

I. General information

NPI: 1265356778
Provider Name (Legal Business Name): ALJ PRIME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N VINEYARD AVE APT 30
ONTARIO CA
91764-2282
US

IV. Provider business mailing address

1221 N VINEYARD AVE APT 30
ONTARIO CA
91764-2282
US

V. Phone/Fax

Practice location:
  • Phone: 253-419-0948
  • Fax:
Mailing address:
  • Phone: 253-419-0948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. NO GIVEN NAME ANKIT
Title or Position: OWNER
Credential:
Phone: 253-419-0948