Provider Demographics
NPI:1710409719
Name:ADVANTMED PROVIDER NETWORK
Entity Type:Organization
Organization Name:ADVANTMED PROVIDER NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-264-2567
Mailing Address - Street 1:1751 E GARRY AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5814
Mailing Address - Country:US
Mailing Address - Phone:949-313-7934
Mailing Address - Fax:949-309-2797
Practice Address - Street 1:1751 E GARRY AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5814
Practice Address - Country:US
Practice Address - Phone:949-313-7934
Practice Address - Fax:949-309-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health