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NPI Code Detail

MEDICARE: MARABELLA ALHAMBRA MD S.C.

MEDICARE: MARABELLA ALHAMBRA MD S.C.
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
1174400000XSpecialist

General Provider Information

NPI Number : 1619018520
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARABELLA ALHAMBRA MD S.C.
Provider Business Mailing Address
First Line : 4775 MANHATTAN DR
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2264
Country : US
Telephone Number : 815-397-4600
Fax Number :
Provider Business Practice Location Address
First Line : 4775 MANHATTAN DR
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2264
Country : US
Telephone Number : 815-397-4600
Fax Number :
Authorized Official
Title or Position : BUSINESS DIRECTOR
Name : MANOLO ABALOS
Credential :
Telephone Number : 815-397-4600
Provider Enumeration Date : 02/12/2007
Last Update Date : 08/22/2020

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