MEDICARE: ALLEGRIA 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1790529980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGRIA LLC

Provider Business Mailing Address
First Line	:	616 CLEARWATER PARK RD APT 1206
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-6250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 CLEARWATER PARK RD APT 1206
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-6250
Country	:	US
Telephone Number	:	954-636-0381
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HUMAIRA KHAN
Credential	:	MD
Telephone Number	:	954-636-0381

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	06/21/2024

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