Provider Demographics
NPI:1558699686
Name:ADVANCED PRACTICE SERVICES
Entity Type:Organization
Organization Name:ADVANCED PRACTICE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:UMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-777-3334
Mailing Address - Street 1:20377 SW ACACIA ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-777-3100
Mailing Address - Fax:949-777-3177
Practice Address - Street 1:20377 SW ACACIA ST.
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-777-3100
Practice Address - Fax:949-777-3177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED PHARMACY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABT30023362261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile