Provider Demographics
NPI:1235425307
Name:ADVANCED DIAGNOSTICS
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-785-4785
Mailing Address - Street 1:3500 OVERLAND AVE
Mailing Address - Street 2:A133
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5695
Mailing Address - Country:US
Mailing Address - Phone:323-854-4454
Mailing Address - Fax:
Practice Address - Street 1:3500 OVERLAND AVE
Practice Address - Street 2:A133
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5695
Practice Address - Country:US
Practice Address - Phone:323-854-4454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA984612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty