Provider Demographics
NPI:1174861991
Name:ADVANCED HEART CARE AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:ADVANCED HEART CARE AND WELLNESS CENTER INC
Other - Org Name:ADVANCED HEART CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-816-9856
Mailing Address - Street 1:8585 KNOTT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3896
Mailing Address - Country:US
Mailing Address - Phone:714-816-9856
Mailing Address - Fax:714-821-4482
Practice Address - Street 1:8585 KNOTT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3896
Practice Address - Country:US
Practice Address - Phone:714-816-9856
Practice Address - Fax:714-821-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty