Provider Demographics
NPI:1073675385
Name:ALIANZA MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ALIANZA MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HOOSHMAND
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:323-588-1100
Mailing Address - Street 1:6907 SEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:323-588-1100
Mailing Address - Fax:323-277-0874
Practice Address - Street 1:6907 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-588-1100
Practice Address - Fax:323-277-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080890Medicaid
CAGR0080890Medicaid
=========OtherTAX ID