Provider Demographics
NPI:1063228351
Name:ADVANCE OC
Entity type:Organization
Organization Name:ADVANCE OC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TORHON
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:949-229-0593
Mailing Address - Street 1:31726 RANCHO VIEJO RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2723
Mailing Address - Country:US
Mailing Address - Phone:949-229-0593
Mailing Address - Fax:
Practice Address - Street 1:17621 IRVINE BLVD STE 212
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3131
Practice Address - Country:US
Practice Address - Phone:949-229-0593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare