Healthcare Provider Details

I. General information

NPI: 1215579222
Provider Name (Legal Business Name): ADVANCED COMMUNITY MEDICAL CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 100
LONG BEACH CA
90806-2769
US

IV. Provider business mailing address

447 N PRAIRIE AVE
INGLEWOOD CA
90301-1413
US

V. Phone/Fax

Practice location:
  • Phone: 562-269-0300
  • Fax:
Mailing address:
  • Phone: 310-680-1810
  • Fax: 310-680-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDALL WHITAKER MAXEY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-680-1810