Provider Demographics
NPI:1063237725
Name:PRESTIGE ADV MED
Entity type:Organization
Organization Name:PRESTIGE ADV MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-940-9471
Mailing Address - Street 1:755 N PEACH AVE STE F4
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7253
Mailing Address - Country:US
Mailing Address - Phone:559-940-9471
Mailing Address - Fax:
Practice Address - Street 1:755 N PEACH AVE STE F4
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-7253
Practice Address - Country:US
Practice Address - Phone:559-940-9471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies