Provider Demographics
NPI:1124897400
Name:PACIFIC ADVANTAGE MEDICAL GROUP, INC
Entity type:Organization
Organization Name:PACIFIC ADVANTAGE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLANIGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:323-553-9999
Mailing Address - Street 1:7700 PACIFIC BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6302
Mailing Address - Country:US
Mailing Address - Phone:323-588-6101
Mailing Address - Fax:323-553-6015
Practice Address - Street 1:7700 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6302
Practice Address - Country:US
Practice Address - Phone:323-588-6101
Practice Address - Fax:323-553-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty