Provider Demographics
NPI:1194925792
Name:ADVANCE BARIATRIC CENTER, MEDICAL CORPORATION
Entity type:Organization
Organization Name:ADVANCE BARIATRIC CENTER, MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSHMAND
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NAIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:310-684-4070
Mailing Address - Street 1:301 N AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-5801
Mailing Address - Country:US
Mailing Address - Phone:310-684-4070
Mailing Address - Fax:310-684-4077
Practice Address - Street 1:301 N AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-5801
Practice Address - Country:US
Practice Address - Phone:310-684-4070
Practice Address - Fax:310-684-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81554174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A815540Medicaid
CAH98713Medicare UPIN
CAW17953Medicare PIN