Provider Demographics
NPI:1336800721
Name:ALLIED FAMILY HEALTH LLC
Entity Type:Organization
Organization Name:ALLIED FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:239-319-3933
Mailing Address - Street 1:3208 CHIQUITA BLVD S STE 108
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4267
Mailing Address - Country:US
Mailing Address - Phone:800-933-2076
Mailing Address - Fax:
Practice Address - Street 1:3208 CHIQUITA BLVD S STE 108
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4267
Practice Address - Country:US
Practice Address - Phone:800-933-2076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty