Provider Demographics
NPI:1619697471
Name:ALCE, EBENS
Entity Type:Individual
Prefix:
First Name:EBENS
Middle Name:
Last Name:ALCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 W DUNLAP AVE APT 233
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2831
Mailing Address - Country:US
Mailing Address - Phone:480-717-0223
Mailing Address - Fax:
Practice Address - Street 1:2506 W DUNLAP AVE APT 233
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2831
Practice Address - Country:US
Practice Address - Phone:480-717-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY886009963OtherID