Provider Demographics
NPI:1093961021
Name:ADVANCED HYPERBARICS RX
Entity Type:Organization
Organization Name:ADVANCED HYPERBARICS RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-527-4000
Mailing Address - Street 1:7499 CERRITOS AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-2008
Mailing Address - Country:US
Mailing Address - Phone:714-527-4000
Mailing Address - Fax:714-527-4002
Practice Address - Street 1:7499 CERRITOS AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-2008
Practice Address - Country:US
Practice Address - Phone:714-527-4000
Practice Address - Fax:714-527-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14096261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center