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General NPI Number Information
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NPI Number | 1457091464
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Entity Type | Organization
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Legal Business Name | ALTERNATIVE HEALTH, PROF L.L.C
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 1465 TERMINAL WAY STE 5
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City | RENO
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State | NV
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Zip | 89502-3200
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Country | US
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Telephone | 775-384-3170
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11248
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City | RENO
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State | NV
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Zip | 89510-1248
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Country | US
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Telephone | 775-384-3170
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | DAVID LEROY PROTHRO
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Credential | MD
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Telephone | 775-384-3170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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