Basic Information
| Provider Information | |||||||||
| NPI: | 1720675986 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH SERVICE ALLIANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 S INDIAN HILL BLVD STE F | ||||||||
| Address2: | |||||||||
| City: | CLAREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917114929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092815800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 220 S INDIAN HILL BLVD STE F | ||||||||
| Address2: | |||||||||
| City: | CLAREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917114929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092815800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2020 | ||||||||
| LastUpdateDate: | 12/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COX | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9094649675 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 12/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 103T00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.