| Advanced California Medical Center, Inc. | |
|
10737 Camino Ruiz Suite 114 San Diego CA 92126-2359 | |
| (858) 578-9600 | |
| (858) 578-9065 |
| Full Name | Advanced California Medical Center, Inc. |
|---|---|
| Speciality | Obstetrics & Gynecology |
| Location | 10737 Camino Ruiz, San Diego, California |
| Authorized Official Name and Position | Deena S Tajran (OWNER PRESIDENT) |
| Authorized Official Contact | 8585789600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced California Medical Center, Inc. 1934 Via Casa Alta La Jolla CA 92037-5730 Ph: (858) 578-9600 | Advanced California Medical Center, Inc. 10737 Camino Ruiz Suite 114 San Diego CA 92126-2359 Ph: (858) 578-9600 |
| NPI Number | 1962597807 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 07/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962597807 | NPI | - | NPPES |
| ZZZ65932Z | Other | CA | BLUE SHIELD CA |
| ZZZ65933Z | Other | CA | BLUE SHIELD CA |
| 774581 | Other | BLUE SHIELD CA | |
| 00A551540 | Medicaid | CA | |
| ZZZ65931Z | Other | CA | BLUE SHIELD CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A55154 (California) | Secondary |
| 207V00000X | Obstetrics & Gynecology | A55154 (California) | Primary |
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