Healthcare Provider Details

I. General information

NPI: 1922358787
Provider Name (Legal Business Name): AVANCE SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N AVENUE 53
LOS ANGELES CA
90042-4005
US

IV. Provider business mailing address

PO BOX 42095
LOS ANGELES CA
90042-4005
US

V. Phone/Fax

Practice location:
  • Phone: 323-230-7270
  • Fax:
Mailing address:
  • Phone: 323-230-7270
  • Fax: 213-652-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RICARDO MIRELES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 323-230-7270