Provider Demographics
NPI:1518002898
Name:ADVANCED MEDICAL ANALYSIS, LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL ANALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-305-5709
Mailing Address - Street 1:1941 WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4846
Mailing Address - Country:US
Mailing Address - Phone:626-305-5709
Mailing Address - Fax:
Practice Address - Street 1:1941 WALKER AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-4846
Practice Address - Country:US
Practice Address - Phone:626-305-5709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF10748291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB87531GMedicaid
CAZZZ51790ZOtherBLUE SHIELD PROVIDER
CALAB87531GMedicaid