Provider Demographics
NPI:1912182684
Name:ALFA ALLIED MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ALFA ALLIED MEDICAL GROUP INC
Other - Org Name:ALFA ALLIED MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-745-3636
Mailing Address - Street 1:1005 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90021-3020
Mailing Address - Country:US
Mailing Address - Phone:213-745-3636
Mailing Address - Fax:213-745-3626
Practice Address - Street 1:1005 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-3020
Practice Address - Country:US
Practice Address - Phone:213-745-3636
Practice Address - Fax:213-745-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A929650Medicaid
CA00A761580Medicaid
CA00A761580Medicaid
CAWA92965AMedicare PIN
CAA76158Medicare PIN