Provider Demographics
NPI:1366215683
Name:ADVOCATE FAMILY MEDICINE CLINIC
Entity type:Organization
Organization Name:ADVOCATE FAMILY MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMEERAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHALIKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-238-4749
Mailing Address - Street 1:6191 DAVIDSON ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1126
Mailing Address - Country:US
Mailing Address - Phone:951-238-4749
Mailing Address - Fax:
Practice Address - Street 1:1330 W COVINA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3200
Practice Address - Country:US
Practice Address - Phone:626-999-9118
Practice Address - Fax:626-999-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty