Amvi Medical Group

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

A340910 Issued in CA

Legal business name

AMVI MEDICAL GROUP

Practice address

1920 E. 17TH Street
Suite 200
Santa Ana, CA 92705

Phone

(714) 796-5900

Fax

(714) 560-7655

NPI assigned

Apr 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Co D.L. Pham, M.D.

Title

Group President

Phone

(714) 796-5900

Specialties & licenses 1

Addresses

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322784000000",
    "number": "1043433220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 E. 17TH STREET",
            "address_2": "SUITE 200",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92705",
            "telephone_number": "714-796-5900",
            "fax_number": "714-560-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 E. 17TH STREET",
            "address_2": "SUITE 200",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92705",
            "telephone_number": "714-796-5900",
            "fax_number": "714-560-7655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMVI MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2011-12-02",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "CO",
        "authorized_official_middle_name": "D.L.",
        "authorized_official_title_or_position": "GROUP PRESIDENT",
        "authorized_official_telephone_number": "714-796-5900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "CA",
            "license": "A340910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Alejandra Anacleto
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• Rocio Anaya
• Rudy Ancheta Sanchez, LVN

• Health Maintenance Organization in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Health Maintenance Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.