Provider Demographics
NPI:1083027528
Name:ADVANCED GERIATRICS & PRIMARY CARE LLC
Entity Type:Organization
Organization Name:ADVANCED GERIATRICS & PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGUCHI ALDRETE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-870-2752
Mailing Address - Street 1:9013 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-9416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:832-415-9400
Practice Address - Street 1:9013 UNIVERSITY PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-9416
Practice Address - Country:US
Practice Address - Phone:713-870-2752
Practice Address - Fax:832-415-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty