1972030427 NPI number — ADVANCED MEDICAL & SURGICAL VENTURES CORPORATION

Table of content: (NPI 1972030427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972030427 NPI number — ADVANCED MEDICAL & SURGICAL VENTURES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MEDICAL & SURGICAL VENTURES CORPORATION
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:
1972030427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16758
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90209-2758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 S GLENDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91205-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-547-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SHARIM
Authorized Official First Name:
HOMAYOUN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-625-6642

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , 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)





Copyright © 2007-2025 www.npivalidator.com