Provider Demographics
NPI:1588732739
Name:ADVANTAGE MEDICAL GROUP APC
Entity type:Organization
Organization Name:ADVANTAGE MEDICAL GROUP APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-465-9300
Mailing Address - Street 1:9903 CAMPO ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1609
Mailing Address - Country:US
Mailing Address - Phone:619-465-9300
Mailing Address - Fax:619-465-9373
Practice Address - Street 1:9903 CAMPO ROAD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1609
Practice Address - Country:US
Practice Address - Phone:619-465-9300
Practice Address - Fax:619-465-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty