OrganizationActive
Access Alliance Medical Group, Inc
NPI 1629534045 · Primary Care Nurse Practitioner · Glendale, CA
Provider details
- NPI number
- 1629534045
- Entity type
- Organization
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Charlie Ponce, Chief Finance Officer(323) 899-4988
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Physician Assistant363A00000X
Physician Assistants & Advanced Practice Nursing Providers
Practice location
644 W Broadway Ste 114
Glendale, CA 91204-1026
Phone: (323) 899-4988
Approximate (ZIP-level) locationGet directions
Mailing address
105 W Alameda Ave Ste 210
Burbank, CA 91502-2254
Registry dates
- Enumerated
- 2019-02-11
- Last updated
- 2025-06-26
- Certified
- 2025-06-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.