Healthcare Provider Details

I. General information

NPI: 1336747013
Provider Name (Legal Business Name): ADVANCED HEALTHCARE ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N STATE COLLEGE BLVD STE C
FULLERTON CA
92831-4236
US

IV. Provider business mailing address

4800 GAGE AVE STE 4
BELL CA
90201-1425
US

V. Phone/Fax

Practice location:
  • Phone: 213-306-8129
  • Fax: 866-200-6794
Mailing address:
  • Phone: 562-565-3529
  • Fax: 668-200-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ANA V MONCADA
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 562-565-3529