Provider Demographics
NPI:1235414343
Name:ADVANTAGE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:ADVANTAGE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNDANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-547-0077
Mailing Address - Street 1:9663 TIERRA GRANDE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4570
Mailing Address - Country:US
Mailing Address - Phone:858-547-0077
Mailing Address - Fax:858-547-0078
Practice Address - Street 1:9663 TIERRA GRANDE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4570
Practice Address - Country:US
Practice Address - Phone:858-547-0077
Practice Address - Fax:858-547-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001984251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550001984OtherCDPH LICENSE
CA551686Medicare Oscar/Certification