Provider Demographics
NPI:1912550047
Name:ALLYON MEDICAL
Entity Type:Organization
Organization Name:ALLYON MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CODIROLI-AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-904-8104
Mailing Address - Street 1:PO BOX 4420
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-4420
Mailing Address - Country:US
Mailing Address - Phone:760-904-8104
Mailing Address - Fax:
Practice Address - Street 1:2800 GOLF CLUB DR APT H9
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-6522
Practice Address - Country:US
Practice Address - Phone:760-904-8104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty