Organization
ADVANCED MSO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LILI MANEEROD MHA (PRESIDENT)
(626) 506-5564
Entity
Organization
Contact information
Practice address
18800 AMAR RD STE B2, WALNUT, CA 91789-7100
(888) 998-9833
Mailing address
18800 AMAR RD STE B2, WALNUT, CA 91789-7100
(626) 506-5564
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
302R00000X
Health Maintenance Organization
Primary
—
—
305R00000X
Preferred Provider Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4297034
SECRETARY OF STATE ARTICLES OF INCORPORATION
CA
Enumeration date
03/05/2020
Last updated
03/05/2020
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