Provider Demographics
NPI:1124866959
Name:AMPLIFY PHYSICIANS OF CALIFORNIA PC
Entity type:Organization
Organization Name:AMPLIFY PHYSICIANS OF CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-739-6200
Mailing Address - Street 1:6125 LUTHER LN # 572
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6202
Mailing Address - Country:US
Mailing Address - Phone:312-608-4584
Mailing Address - Fax:
Practice Address - Street 1:4403 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2413
Practice Address - Country:US
Practice Address - Phone:323-232-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMPLIFY PHYSICIANS OF CALIFORNIA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center