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General NPI Number Information
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NPI Number | 1578997573
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Entity Type | Organization
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Legal Business Name | ALPHA OMEGA ALLIANCE INC
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 31 W 20TH ST
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City | RIVIERA BEACH
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State | FL
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Zip | 33404
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Country | US
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Telephone | 561-229-1659
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Fax | 561-331-2715
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Provider Business Mailing Address
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Address Line | 31 W 20TH ST
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-6155
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Country | US
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Telephone | 561-899-9140
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Fax | 561-331-2715
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MONIQUE D WELLONS
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Credential |
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Telephone | 561-899-9149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice 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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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