Provider Demographics
NPI:1477100378
Name:ADVANCED CARE ORTHOPEDICS
Entity Type:Organization
Organization Name:ADVANCED CARE ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAFAGH
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAZZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-569-1126
Mailing Address - Street 1:16215 WAYFARER LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2149
Mailing Address - Country:US
Mailing Address - Phone:714-595-2248
Mailing Address - Fax:
Practice Address - Street 1:4067 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6146
Practice Address - Country:US
Practice Address - Phone:323-569-1126
Practice Address - Fax:877-403-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-25
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center