Healthcare Provider Details

I. General information

NPI: 1750379129
Provider Name (Legal Business Name): ALHAMBRA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 SW 87TH AVE SUITE 104
MIAMI FL
33165-5400
US

IV. Provider business mailing address

PO BOX 557457
MIAMI FL
33255-7457
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-9938
  • Fax: 305-554-8288
Mailing address:
  • Phone: 305-223-9938
  • Fax: 305-554-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FELIX J GONZALEZ
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 305-223-9938