Provider Demographics
NPI:1073877916
Name:CALIFORNIA ADVANCED SPECIALTY HEALTHCARE AMC
Entity Type:Organization
Organization Name:CALIFORNIA ADVANCED SPECIALTY HEALTHCARE AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-701-1800
Mailing Address - Street 1:333 WASHINGTON BLVD
Mailing Address - Street 2:513
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5136
Mailing Address - Country:US
Mailing Address - Phone:818-701-1800
Mailing Address - Fax:818-885-1171
Practice Address - Street 1:1440 E 1ST ST
Practice Address - Street 2:100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-6384
Practice Address - Country:US
Practice Address - Phone:818-701-1800
Practice Address - Fax:818-885-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty