Organization
ADVANCED MEDICAL DOCTORS OF CALIFORNIA, IPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE STEWART BLACK ETC (ADMINISTRATOR)
(626) 943-7465
Entity
Organization
Contact information
Practice address
1020 S. GARFIELD AVE., ALHAMBRA, CA 91801-4762
(626) 943-7465
(626) 458-8051
Mailing address
1020 S. GARFIELD AVE., ALHAMBRA, CA 91801-4762
(626) 943-7465
(626) 458-8051
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
A64044
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A64044
STATE LICENSE (CALIFORNIA)
CA
Enumeration date
01/29/2013
Last updated
11/12/2024
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