Provider Demographics
NPI:1114574340
Name:ALCAM MEDICAL INC
Entity Type:Organization
Organization Name:ALCAM MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALPHA
Authorized Official - Middle Name:ISCANDARI
Authorized Official - Last Name:SANUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-782-7000
Mailing Address - Street 1:1760 CHICAGO AVE STE L21
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2326
Mailing Address - Country:US
Mailing Address - Phone:877-310-1729
Mailing Address - Fax:877-310-1729
Practice Address - Street 1:2492 WALNUT AVE STE 220
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6960
Practice Address - Country:US
Practice Address - Phone:866-847-7187
Practice Address - Fax:877-310-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier