Provider Demographics
NPI:1376928010
Name:ALLIANCE MEDICAL, LLC
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-660-3510
Mailing Address - Street 1:409 N PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 166
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2870
Mailing Address - Country:US
Mailing Address - Phone:805-660-3510
Mailing Address - Fax:866-225-3208
Practice Address - Street 1:409 N PACIFIC COAST HWY
Practice Address - Street 2:SUITE 166
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2870
Practice Address - Country:US
Practice Address - Phone:805-660-3510
Practice Address - Fax:866-225-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty