| Advanced Care Medical Inc | |
|
400 Newport Center Dr Ste 301 Newport Beach CA 92660-7604 | |
| (949) 644-1300 | |
| (949) 644-1306 |
| Full Name | Advanced Care Medical Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 400 Newport Center Dr Ste 301, Newport Beach, California |
| Authorized Official Name and Position | Luther Mangoba (PRESIDENT) |
| Authorized Official Contact | 9516407822 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Care Medical Inc 400 Newport Center Dr Ste 301 Newport Beach CA 92660-7604 Ph: (951) 640-7822 | Advanced Care Medical Inc 400 Newport Center Dr Ste 301 Newport Beach CA 92660-7604 Ph: (949) 644-1300 |
| NPI Number | 1821607789 |
|---|---|
| Provider Enumeration Date | 07/27/2020 |
| Last Update Date | 07/27/2020 |
| Medicare PECOS PAC ID | 7517385792 |
|---|---|
| Medicare Enrollment ID | O20200921001888 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821607789 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Luther Mangoba |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528041894 PECOS PAC ID: 2466403860 Enrollment ID: I20050202000963 |
| Provider Name | Jaquolin Eskandr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508219718 PECOS PAC ID: 3971926627 Enrollment ID: I20200714000856 |
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