Provider Demographics
NPI:1134263817
Name:ADVANCED INTEGRATED MEDICAL GROUP
Entity type:Organization
Organization Name:ADVANCED INTEGRATED MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGOMARSINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-932-8851
Mailing Address - Street 1:5637 N PERSHING AVE
Mailing Address - Street 2:STE F1
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-952-8851
Mailing Address - Fax:209-952-8823
Practice Address - Street 1:100 WEST JACKSON ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544
Practice Address - Country:US
Practice Address - Phone:510-786-3300
Practice Address - Fax:510-786-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27930111N00000X
CAC42153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty