Advanced Medical Doctors of California, Ipa

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

A64044 Issued in CA

Legal business name

ADVANCED MEDICAL DOCTORS OF CALIFORNIA, IPA

Practice address

1020 S. Garfield Ave.
Alhambra, CA 91801-4762

Phone

(626) 943-7465

Fax

(626) 458-8051

NPI assigned

Jan 29, 2013

Last updated

Nov 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michelle Stewart Black, ETC

Title

Administrator

Phone

(626) 943-7465

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1359417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1114265907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 S. GARFIELD AVE.",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918014762",
            "telephone_number": "626-943-7465",
            "fax_number": "626-458-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 S. GARFIELD AVE.",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918014762",
            "telephone_number": "626-943-7465",
            "fax_number": "626-458-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MEDICAL DOCTORS OF CALIFORNIA, IPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-29",
        "last_updated": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "STEWART",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "626-943-7465",
        "authorized_official_credential": "ETC"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "CA",
            "license": "A64044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE  (CALIFORNIA)",
            "identifier": "A64044",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Health Maintenance Organization in Alhambra, CA
• Providers in Alhambra, 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 Nov 12, 2024; 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.