Provider Demographics
NPI:1124440219
Name:ADVANCED SPECIALTY MEDICAL CENTER
Entity type:Organization
Organization Name:ADVANCED SPECIALTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-501-3366
Mailing Address - Street 1:16661 VENTURA BLVD STE 815
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1996
Mailing Address - Country:US
Mailing Address - Phone:818-501-3366
Mailing Address - Fax:818-906-7961
Practice Address - Street 1:16661 VENTURA BLVD STE 815
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1996
Practice Address - Country:US
Practice Address - Phone:818-501-3366
Practice Address - Fax:818-906-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26550204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty