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General NPI Number Information
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NPI Number | 1104635515
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Entity Type | Organization
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Legal Business Name | DR ALA STANFORD CENTER FOR HEALTH EQUITY
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Dates
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Enumeration Date | 01/01/2025
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 7979 STATE RD
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City | PHILADELPHIA
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State | PA
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Zip | 19136-3407
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Country | US
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Telephone | 484-270-6200
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Fax | 484-270-6200
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Provider Business Mailing Address
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Address Line | 2001 W LEHIGH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19132-2652
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Country | US
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Telephone | 484-270-6200
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Fax | 484-270-6200
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MRS. CYNTHIA ANTOINETTE TAYLOR
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Credential |
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Telephone | 484-270-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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