Provider Demographics
NPI:1376583344
Name:ALAMITOS IPA
Entity Type:Organization
Organization Name:ALAMITOS IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:562-602-1563
Mailing Address - Street 1:4909 LAKEWOOD BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2405
Mailing Address - Country:US
Mailing Address - Phone:562-602-1563
Mailing Address - Fax:562-531-0937
Practice Address - Street 1:4909 LAKEWOOD BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2405
Practice Address - Country:US
Practice Address - Phone:562-602-1563
Practice Address - Fax:562-531-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2012-09-26
Deactivation Date:2009-10-28
Deactivation Code:
Reactivation Date:2012-09-26
Provider Licenses
StateLicense IDTaxonomies
CA011549302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization