Provider Demographics
NPI:1851799332
Name:HEALTH ADVANTAGE PHYSICAL MEDICINE INC
Entity Type:Organization
Organization Name:HEALTH ADVANTAGE PHYSICAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-798-7805
Mailing Address - Street 1:1450 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2301
Mailing Address - Country:US
Mailing Address - Phone:626-798-7805
Mailing Address - Fax:626-798-7800
Practice Address - Street 1:1450 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2301
Practice Address - Country:US
Practice Address - Phone:626-798-7805
Practice Address - Fax:626-798-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty