Provider Demographics
NPI:1871083188
Name:ALLIANCE OF LATINO HEALTH SERVICES MEDICAL GROUP INC
Entity type:Organization
Organization Name:ALLIANCE OF LATINO HEALTH SERVICES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSHTAQ
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:657-267-7263
Mailing Address - Street 1:517 N MAIN ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-6703
Mailing Address - Country:US
Mailing Address - Phone:657-267-7263
Mailing Address - Fax:714-647-0135
Practice Address - Street 1:517 N MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-6703
Practice Address - Country:US
Practice Address - Phone:657-267-7263
Practice Address - Fax:714-647-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty