Provider Demographics
NPI:1356427009
Name:ADVANCED CARDIOVASCULAR MEDICAL ASSOCIATES INC.
Entity type:Organization
Organization Name:ADVANCED CARDIOVASCULAR MEDICAL ASSOCIATES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABUDAYEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-886-6878
Mailing Address - Street 1:1022 MURRIETA BLVD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550
Mailing Address - Country:US
Mailing Address - Phone:925-961-8920
Mailing Address - Fax:925-961-8923
Practice Address - Street 1:1022 MURRIETA BLVD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4111
Practice Address - Country:US
Practice Address - Phone:925-961-8920
Practice Address - Fax:925-961-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ60982ZOtherBLUE SHIELD
CAGR0087720Medicaid
ZZZ18193ZMedicare ID - Type Unspecified