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Organization
ACCESS ALLIANCE MEDICAL GROUP, INC
Active
Organization
ACCESS ALLIANCE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLIE A PONCE (CHIEF FINANCE OFFICER)
(323) 899-4988
Entity
Organization
Contact information
Practice address
644 W BROADWAY STE 114, GLENDALE, CA 91204-1026
(323) 899-4988
Mailing address
105 W ALAMEDA AVE STE 210, BURBANK, CA 91502-2254
(323) 899-4988
(818) 588-3058
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/11/2019
Last updated
06/26/2025
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