Provider Demographics
NPI:1568611697
Name:ALERT MEDIA, INC.
Entity Type:Organization
Organization Name:ALERT MEDIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:OSVALDO
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-601-8170
Mailing Address - Street 1:9345 PIONEER BLVD
Mailing Address - Street 2:#202
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-2387
Mailing Address - Country:US
Mailing Address - Phone:310-601-8170
Mailing Address - Fax:310-693-8012
Practice Address - Street 1:9345 PIONEER BLVD
Practice Address - Street 2:#202
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-2387
Practice Address - Country:US
Practice Address - Phone:310-601-8170
Practice Address - Fax:310-693-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15739103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY157391OtherMEDI-CAL