=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174085567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE INFUSIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2019
-----------------------------------------------------
Last Update Date | 08/31/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8541 E ANDERSON DR STE 104
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-5430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-300-9055
-----------------------------------------------------
Fax | 602-428-9963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8541 E ANDERSON DR STE 104
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-5430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-300-9055
-----------------------------------------------------
Fax | 602-428-9963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPLE
-----------------------------------------------------
Name | MR. ERNESTO GARZA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-300-9055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------