Advanced California Medical Center, Inc.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

A55154 Issued in CA

Legal business name

ADVANCED CALIFORNIA MEDICAL CENTER, INC.

Practice address

10737 Camino Ruiz
Suite 114
San Diego, CA 92126-2359

Phone

(858) 578-9600

Fax

(858) 578-9065

NPI assigned

Oct 4, 2006

Organization subpart

Yes

Parent organization

ADVANCED CALIFORNIA MEDICAL CENTER, INC.As reported in NPPES

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

Authorized official

Name

Mrs. Deena S Tajran, MD FACOG

Title

Owner President

Phone

(858) 578-9600

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• Advanced California Medical Center, Inc. Doing business as

Part of

Advanced California Medical

Locations

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437350400000",
    "number": "1962597807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1934 VIA CASA ALTA",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920375730",
            "telephone_number": "858-578-9600",
            "fax_number": "858-578-9065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10737 CAMINO RUIZ",
            "address_2": "SUITE 114",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921262359",
            "telephone_number": "858-578-9600",
            "fax_number": "858-578-9065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED CALIFORNIA MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED CALIFORNIA MEDICAL CENTER, INC.",
        "enumeration_date": "2006-10-04",
        "last_updated": "2015-07-20",
        "status": "A",
        "authorized_official_last_name": "TAJRAN",
        "authorized_official_first_name": "DEENA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "858-578-9600",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD FACOG"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A55154",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A55154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD CA",
            "identifier": "ZZZ65932Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD CA",
            "identifier": "ZZZ65933Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD CA",
            "identifier": "774581",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A551540",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD CA",
            "identifier": "ZZZ65931Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced California Medical Center, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Obstetrics & Gynecology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2015; 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.