Provider Demographics
NPI:1275115305
Name:ALBONIJIM, ALLA
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:ALBONIJIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24405 BUCHANAN CT APT 1927
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2152
Mailing Address - Country:US
Mailing Address - Phone:313-404-3094
Mailing Address - Fax:
Practice Address - Street 1:24405 BUCHANAN CT APT 1927
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2152
Practice Address - Country:US
Practice Address - Phone:313-404-3094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program