Provider Demographics
NPI:1770785818
Name:ALLIANCE PHYSICIANS MEDICAL GROUP
Entity type:Organization
Organization Name:ALLIANCE PHYSICIANS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-602-1563
Mailing Address - Street 1:4909 LAKEWOOD BLVD
Mailing Address - Street 2:200
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4909 LAKEWOOD BLVD
Practice Address - Street 2:200
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2405
Practice Address - Country:US
Practice Address - Phone:562-602-1563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty