Basic Information
| Provider Information | |||||||||
| NPI: | 1508916966 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INSTITUTE FOR HEALTHCARE ADVANCEMENT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FRIENDS OF CHILDREN HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 S IDAHO ST | ||||||||
| Address2: | SUITE#300 | ||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906316047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626904001 | ||||||||
| FaxNumber: | 5626908988 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S IDAHO ST | ||||||||
| Address2: | SUITE #190 | ||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906316047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626900400 | ||||||||
| FaxNumber: | 5626903182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 02/24/2010 | ||||||||
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| AuthorizedOfficialLastName: | GILMORE | ||||||||
| AuthorizedOfficialFirstName: | CATREACE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BILLING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5626904001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.