Healthcare Provider Details

I. General information

NPI: 1730729674
Provider Name (Legal Business Name): AHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 E ARABIAN LN
SPOKANE WA
99208-6735
US

IV. Provider business mailing address

31959 10TH AVE STE B
LAGUNA BEACH CA
92651-6838
US

V. Phone/Fax

Practice location:
  • Phone: 949-466-9939
  • Fax: 949-281-7707
Mailing address:
  • Phone: 800-558-0312
  • Fax: 949-281-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTIN CANALES
Title or Position: MEMBER
Credential:
Phone: 949-466-9939