Provider Demographics
NPI:1972685493
Name:ADVANCED PHYSICAL MEDICINE & REHAB GROUP, INC.
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE & REHAB GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIGNA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-465-3668
Mailing Address - Street 1:300 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4826
Mailing Address - Country:US
Mailing Address - Phone:510-465-3668
Mailing Address - Fax:510-465-1332
Practice Address - Street 1:300 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4826
Practice Address - Country:US
Practice Address - Phone:510-465-3668
Practice Address - Fax:510-465-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01970ZMedicare PIN
CA5826090001Medicare NSC