Provider Demographics
NPI:1326149998
Name:ADVANTAGE MEDICAL CENTER, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL CENTER, A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-963-0955
Mailing Address - Street 1:17931 EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5409
Mailing Address - Country:US
Mailing Address - Phone:714-963-0955
Mailing Address - Fax:714-963-5775
Practice Address - Street 1:17931 EUCLID ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5409
Practice Address - Country:US
Practice Address - Phone:714-963-0955
Practice Address - Fax:714-963-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20248Medicare PIN