Provider Demographics
NPI:1407995269
Name:MEDICAL ALLIANCE GROUP
Entity Type:Organization
Organization Name:MEDICAL ALLIANCE GROUP
Other - Org Name:MEDICAL ALLIANCE GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-746-0808
Mailing Address - Street 1:COND SANTA JUANA
Mailing Address - Street 2:CALLE 15 N-29
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2107
Mailing Address - Country:US
Mailing Address - Phone:787-746-0808
Mailing Address - Fax:787-744-3156
Practice Address - Street 1:AVE. GARRIDO N29
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2107
Practice Address - Country:US
Practice Address - Phone:787-746-0808
Practice Address - Fax:787-744-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4396430001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4396430001Medicare NSC