Provider Demographics
NPI:1508546003
Name:ADVANCED HORMONE REPLACEMENT
Entity Type:Organization
Organization Name:ADVANCED HORMONE REPLACEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORREIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-540-1306
Mailing Address - Street 1:122 PEARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2910
Mailing Address - Country:US
Mailing Address - Phone:805-540-1306
Mailing Address - Fax:
Practice Address - Street 1:562 CAMINO MERCADO
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1815
Practice Address - Country:US
Practice Address - Phone:805-410-8971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty