Healthcare Provider Details

I. General information

NPI: 1467840561
Provider Name (Legal Business Name): LA RED HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21444 CARMEAN WAY
GEORGETOWN DE
19947
US

IV. Provider business mailing address

21444 CARMEAN WAY
GEORGETOWN DE
19947
US

V. Phone/Fax

Practice location:
  • Phone: 302-855-1233
  • Fax: 302-855-1020
Mailing address:
  • Phone: 302-855-1233
  • Fax: 302-855-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FABRICIO ALARCON
Title or Position: CHIEF CLINICAL SUPERVISOR
Credential: M.D.
Phone: 302-855-1233