Provider Demographics
NPI:1982730800
Name:ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.
Other - Org Name:HIDDEN VALLEY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDNET
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-963-8802
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94576-0266
Mailing Address - Country:US
Mailing Address - Phone:877-302-0777
Mailing Address - Fax:732-302-0467
Practice Address - Street 1:18990 COYOTE VALLEY ROAD
Practice Address - Street 2:SUITE 8
Practice Address - City:HIDDEN VALLEY LAKE
Practice Address - State:CA
Practice Address - Zip Code:95467
Practice Address - Country:US
Practice Address - Phone:707-987-8395
Practice Address - Fax:707-987-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty