Provider Demographics
NPI:1568173623
Name:ADVANCE HEALTHMED INC
Entity Type:Organization
Organization Name:ADVANCE HEALTHMED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETROS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATATANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-290-3258
Mailing Address - Street 1:14532 FRIAR ST STE G
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2358
Mailing Address - Country:US
Mailing Address - Phone:818-290-3258
Mailing Address - Fax:
Practice Address - Street 1:14532 FRIAR ST STE G
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2358
Practice Address - Country:US
Practice Address - Phone:818-290-3258
Practice Address - Fax:818-290-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
3334959-0001-0OtherBUSINESS LICENSE