1235414343 NPI number — ADVANTAGE HEALTH SYSTEMS

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 1235414343 NPI number — ADVANTAGE HEALTH SYSTEMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANTAGE HEALTH SYSTEMS
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:
1235414343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9663 TIERRA GRANDE ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92126-4570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-547-0077
Provider Business Mailing Address Fax Number:
858-547-0078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9663 TIERRA GRANDE ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-4570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-547-0077
Provider Business Practice Location Address Fax Number:
858-547-0078
Provider Enumeration Date:
10/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BUNDANG
Authorized Official First Name:
EMIL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
858-547-0077

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  550001984 , 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)

  • Identifier: 550001984 . This is a "CDPH LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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