Provider Demographics
NPI:1013552124
Name:ALLIANCE WITH THE COVENANT OF THE TRINITY ARIZONA INC
Entity Type:Organization
Organization Name:ALLIANCE WITH THE COVENANT OF THE TRINITY ARIZONA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:ZANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-709-0777
Mailing Address - Street 1:11245 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4219
Mailing Address - Country:US
Mailing Address - Phone:213-709-0777
Mailing Address - Fax:
Practice Address - Street 1:2 N CENTRAL AVE FL 18
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2322
Practice Address - Country:US
Practice Address - Phone:213-709-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty