Healthcare Provider Details

I. General information

NPI: 1164586103
Provider Name (Legal Business Name): ALCAM MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 CHICAGO AVE STE M13
RIVERSIDE CA
92507-2033
US

IV. Provider business mailing address

1660 CHICAGO AVE STE M13
RIVERSIDE CA
92507-2033
US

V. Phone/Fax

Practice location:
  • Phone: 866-847-7187
  • Fax: 877-310-1729
Mailing address:
  • Phone: 866-847-7187
  • Fax: 877-310-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number54736
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number46553
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ALPHA SANUSI
Title or Position: PRESIDENT
Credential:
Phone: 951-782-7000