Provider Demographics
NPI:1396781894
Name:ALLERGY CARE CENTER A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ALLERGY CARE CENTER A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KANTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-482-8989
Mailing Address - Street 1:2412 N PONDEROSA DR
Mailing Address - Street 2:SUITE B111
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2373
Mailing Address - Country:US
Mailing Address - Phone:805-482-8989
Mailing Address - Fax:805-987-2855
Practice Address - Street 1:2412 N PONDEROSA DR
Practice Address - Street 2:SUITE B111
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2373
Practice Address - Country:US
Practice Address - Phone:805-482-8989
Practice Address - Fax:805-987-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34328174400000X
CAA74064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA74064AMedicare ID - Type UnspecifiedCRISTINA N. PORCH-CURREN,
CAH59666Medicare UPIN
CAWG34328BMedicare ID - Type UnspecifiedLEWIS KANTER
CAA45882Medicare UPIN
CAW18677Medicare ID - Type UnspecifiedGROUP ID