Provider Demographics
NPI:1407186885
Name:ADVANCED EAR NOSE AND THROAT MEDICAL GROUP PC
Entity Type:Organization
Organization Name:ADVANCED EAR NOSE AND THROAT MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-552-6444
Mailing Address - Street 1:PO BOX 14994
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-4994
Mailing Address - Country:US
Mailing Address - Phone:949-552-6444
Mailing Address - Fax:949-552-1858
Practice Address - Street 1:3500 BARRANCA PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8226
Practice Address - Country:US
Practice Address - Phone:949-552-6444
Practice Address - Fax:949-552-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty