Healthcare Provider Details

I. General information

NPI: 1013638238
Provider Name (Legal Business Name): REFUGIO GREGORIO ALCALA MA, LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E BELTLINE AVE NE
GRAND RAPIDS MI
49506-1214
US

IV. Provider business mailing address

150 S LAKE DOSTER DR
PLAINWELL MI
49080-9117
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-3660
  • Fax:
Mailing address:
  • Phone: 616-617-2569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6361008358
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: