1851430805 NPI number — ALTA VIEW HEALTH CARE LLC

Table of content: (NPI 1851430805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851430805 NPI number — ALTA VIEW HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTA VIEW HEALTH CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE MEDICINE SHOPPE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851430805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
296 H ST STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91910-4779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-470-4550
Provider Business Mailing Address Fax Number:
619-470-6709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
296 H ST STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-4779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-470-4550
Provider Business Practice Location Address Fax Number:
619-470-6709
Provider Enumeration Date:
02/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALQAZQI
Authorized Official First Name:
AMJAD
Authorized Official Middle Name:
ABDELQADER A
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
858-250-9623

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X , with the licence number: 55851 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0597700 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1851430805 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".