Provider Demographics
NPI:1508875469
Name:ADVANTAGE HEALTH CARE SERVICES - MISSION INC
Entity Type:Organization
Organization Name:ADVANTAGE HEALTH CARE SERVICES - MISSION INC
Other - Org Name:MISSION PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RAJNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JASANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-948-8377
Mailing Address - Street 1:26800 CROWN VALLEY PKWY
Mailing Address - Street 2:STE 185
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6384
Mailing Address - Country:US
Mailing Address - Phone:949-364-9009
Mailing Address - Fax:949-347-0547
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:STE 185
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-364-9009
Practice Address - Fax:949-347-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY515503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141659OtherPK
7325420001Medicare NSC