Healthcare Provider Details

I. General information

NPI: 1003673096
Provider Name (Legal Business Name): ALTERNATIVE MEDICINE BY BARS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AV. LOS TULES 162 TORRE MEDICA CORALLA, CONSULTORIO 304
PUERTO VALLARTA JALISCO
48310
MX

IV. Provider business mailing address

30 N GOULD ST STE R
SHERIDAN WY
82801
US

V. Phone/Fax

Practice location:
  • Phone: 322-111-7388
  • Fax:
Mailing address:
  • Phone: 833-724-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DECIO BASSO
Title or Position: PARTNER
Credential: M.D.
Phone: 833-724-0005