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General NPI Number Information
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NPI Number | 1700181021
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Entity Type | Organization
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Legal Business Name | ALLIANCE MEDICAL CARE GROUP LLC
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 9869 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6100
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Country | US
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Telephone | 954-450-7998
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Fax | 954-450-9991
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Provider Business Mailing Address
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Address Line | 9869 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6100
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Country | US
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Telephone | 954-450-7998
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Fax | 954-450-9991
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Authorized Official
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Title or Position | PHYSICIAN ASSOCIATE / MANAGER
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Name | MR. JOSE J CASTANEDA
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Credential | M.S.,PA
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Telephone | 954-450-7998
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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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