Healthcare Provider Details

I. General information

NPI: 1780165662
Provider Name (Legal Business Name): ALERRA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 02/11/2023
Certification Date: 02/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32244 PASEO ADELANTO STE B
SAN JUAN CAPISTRANO CA
92675-3617
US

IV. Provider business mailing address

32244 PASEO ADELANTO STE B
SAN JUAN CAPISTRANO CA
92675-3617
US

V. Phone/Fax

Practice location:
  • Phone: 323-559-9683
  • Fax:
Mailing address:
  • Phone: 949-324-5808
  • Fax: 949-485-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN MONROE
Title or Position: GENERAL COUNSEL
Credential:
Phone: 385-240-6408