Provider Demographics
NPI:1881005965
Name:ALIGN MEDICAL GROUP
Entity Type:Organization
Organization Name:ALIGN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TRINIDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CISNEROS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-394-2802
Mailing Address - Street 1:1125 E 17TH ST
Mailing Address - Street 2:SUITE W-117
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2201
Mailing Address - Country:US
Mailing Address - Phone:714-550-6399
Mailing Address - Fax:714-550-6359
Practice Address - Street 1:1125 E 17TH ST
Practice Address - Street 2:SUITE W-117
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2201
Practice Address - Country:US
Practice Address - Phone:714-550-6399
Practice Address - Fax:714-550-6359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-14281111N00000X
CADC-27592111N00000X, 111NX0100X
CAAC-3734171100000X
CAA100315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty