Provider Demographics
NPI:1477269785
Name:ADVANCED LIPEDEMA TREATMENT
Entity Type:Organization
Organization Name:ADVANCED LIPEDEMA TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FURLONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-331-6170
Mailing Address - Street 1:450 N ROXBURY DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4218
Mailing Address - Country:US
Mailing Address - Phone:424-394-1610
Mailing Address - Fax:424-394-1628
Practice Address - Street 1:450 N ROXBURY DR STE 400
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4218
Practice Address - Country:US
Practice Address - Phone:424-394-1610
Practice Address - Fax:424-394-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty