Healthcare Provider Details

I. General information

NPI: 1235578287
Provider Name (Legal Business Name): ALPHA OMEGA ALLIANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W 20TH ST
RIVIERA BEACH FL
33404-6155
US

IV. Provider business mailing address

31 W 20TH ST FIRST FLOOR
RIVIERA BEACH FL
33404-6155
US

V. Phone/Fax

Practice location:
  • Phone: 561-510-0471
  • Fax: 561-331-2715
Mailing address:
  • Phone: 561-510-0471
  • Fax: 561-331-2715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE WELLONS
Title or Position: CEO
Credential: PHD MCAP SAP CTTP
Phone: 561-899-9140