Organization
ADVANCED CALIFORNIA MEDICAL CENTER, INC.
Active
Parent organization
ADVANCED CALIFORNIA MEDICAL CENTER, INC.
Other names
Advanced California Medical Center, Inc.
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADVANCED CALIFORNIA MEDICAL CENTER, INC.
Authorized official
MRS. DEENA S TAJRAN MD FACOG (OWNER PRESIDENT)
(858) 578-9600
Entity
Organization
Contact information
Practice address
10737 CAMINO RUIZ, SUITE 114, SAN DIEGO, CA 92126-2359
(858) 578-9600
(858) 578-9065
Mailing address
1934 VIA CASA ALTA, LA JOLLA, CA 92037-5730
(858) 578-9600
(858) 578-9065
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A55154
CA
207V00000X
Obstetrics & Gynecology Physician
Primary
A55154
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A551540
—
CA
01
—
774581
BLUE SHIELD CA
—
01
—
ZZZ65931Z
BLUE SHIELD CA
CA
01
—
ZZZ65932Z
BLUE SHIELD CA
CA
01
—
ZZZ65933Z
BLUE SHIELD CA
CA
Enumeration date
10/04/2006
Last updated
07/20/2015
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