Provider Demographics
NPI:1255785648
Name:ADVANCED HEALTHCARE CENTER APC
Entity type:Organization
Organization Name:ADVANCED HEALTHCARE CENTER APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAJRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-578-9600
Mailing Address - Street 1:1934 VIA CASA ALTA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5730
Mailing Address - Country:US
Mailing Address - Phone:858-578-9600
Mailing Address - Fax:858-578-9065
Practice Address - Street 1:10737 CAMINO RUIZ
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2359
Practice Address - Country:US
Practice Address - Phone:858-578-9600
Practice Address - Fax:858-578-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55154207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty