1063722627 NPI number — THE ADVANCED MEDICAL INSTITUTE

Table of content: BARBARA ANNE MCKENZIE VANDAHM LMSW (NPI 1619061645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063722627 NPI number — THE ADVANCED MEDICAL INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ADVANCED MEDICAL INSTITUTE
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:
1063722627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19671 BEACH BLVD.
Provider Second Line Business Mailing Address:
SUITE 321
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-969-2520
Provider Business Mailing Address Fax Number:
714-969-7480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19671 BEACH BLVD.
Provider Second Line Business Practice Location Address:
SUITE 321
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92648-5930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-969-2520
Provider Business Practice Location Address Fax Number:
714-969-7480
Provider Enumeration Date:
10/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AL-HAKEEM
Authorized Official First Name:
MAZIN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-969-2520

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com