Provider Demographics
NPI:1619064185
Name:ALIANZA MEDICAL CENTER
Entity Type:Organization
Organization Name:ALIANZA MEDICAL CENTER
Other - Org Name:CORPORATION NAME
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BEHROOZ
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:YAGOOBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-634-1000
Mailing Address - Street 1:6907 SEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNGTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:323-588-1100
Mailing Address - Fax:323-277-0874
Practice Address - Street 1:6907 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:HUNGTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-588-1100
Practice Address - Fax:323-277-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48328207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080890Medicaid
CAF18531Medicare UPIN
CAW16552Medicare ID - Type Unspecified