Provider Demographics
NPI:1164668125
Name:ADVANCED THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANCED THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-246-2539
Mailing Address - Street 1:905 W MAIN ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3162
Mailing Address - Country:US
Mailing Address - Phone:619-246-2539
Mailing Address - Fax:619-441-5929
Practice Address - Street 1:2648 MAIN ST
Practice Address - Street 2:SUITE BC
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4664
Practice Address - Country:US
Practice Address - Phone:619-246-2539
Practice Address - Fax:619-575-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679794481OtherNPI
CAPT27704Medicare PIN
CAWPT10100AMedicare PIN
CAWPT5120BMedicare PIN