MEDICARE: ALLIED FAMILY HEALTH 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	261QM1300X	Multi-Specialty Clinic/Center
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1336800721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED FAMILY HEALTH LLC

Provider Business Mailing Address
First Line	:	3208 CHIQUITA BLVD S STE 108
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4267
Country	:	US
Telephone Number	:	800-933-2076
Fax Number	:

Provider Business Practice Location Address
First Line	:	3208 CHIQUITA BLVD S STE 108
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4267
Country	:	US
Telephone Number	:	800-933-2076
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. AMY L GONZALEZ
Credential	:	APRN
Telephone Number	:	239-319-3933

Provider Enumeration Date	:	01/07/2022
Last Update Date	:	01/23/2024

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