MEDICARE: EL ALHAMBRA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174125496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL ALHAMBRA LLC

Provider Business Mailing Address
First Line	:	11300 NW 87TH CT STE 151
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4520
Country	:	US
Telephone Number	:	305-456-0162
Fax Number	:	305-456-0162

Provider Business Practice Location Address
First Line	:	11300 NW 87TH CT STE 151
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4520
Country	:	US
Telephone Number	:	305-456-0162
Fax Number	:	305-456-0162

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARTHA I. PEREZ GONZALEZ
Credential	:
Telephone Number	:	305-456-0162

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	11/11/2020

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Directions to “EL ALHAMBRA LLC ” Practice Location

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