1124440219 NPI number — ADVANCED SPECIALTY MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124440219 NPI number — ADVANCED SPECIALTY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED SPECIALTY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124440219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16661 VENTURA BLVD STE 815
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91436-1996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-501-3366
Provider Business Mailing Address Fax Number:
818-906-7961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16661 VENTURA BLVD STE 815
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-1996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-501-3366
Provider Business Practice Location Address Fax Number:
818-906-7961
Provider Enumeration Date:
01/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GOEL
Authorized Official First Name:
NADIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
818-501-3366

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , with the licence number:  DC26550 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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