1750528170 NPI number — ADVANCED MEDICAL HOME PHYSICIANS INC

Table of content: (NPI 1750528170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750528170 NPI number — ADVANCED MEDICAL HOME PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MEDICAL HOME PHYSICIANS INC
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:
1750528170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 AVENIDA PICO
Provider Second Line Business Mailing Address:
# C 517
Provider Business Mailing Address City Name:
SAN CLEMENTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92673-6957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-226-8416
Provider Business Mailing Address Fax Number:
877-223-5602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 AVENIDA PICO
Provider Second Line Business Practice Location Address:
# C 517
Provider Business Practice Location Address City Name:
SAN CLEMENTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92673-6957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-226-8416
Provider Business Practice Location Address Fax Number:
949-226-8019
Provider Enumeration Date:
01/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HAGA
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-226-8416

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A81573 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: A64412 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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