Provider Demographics
NPI:1205211851
Name:ALLIANCE HEALTH CLINIC
Entity Type:Organization
Organization Name:ALLIANCE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SIMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHADIVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-286-9052
Mailing Address - Street 1:5952 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3828
Mailing Address - Country:US
Mailing Address - Phone:619-229-8030
Mailing Address - Fax:619-229-8031
Practice Address - Street 1:5952 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3828
Practice Address - Country:US
Practice Address - Phone:619-229-8030
Practice Address - Fax:619-229-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002694261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care