Healthcare Provider Details

I. General information

NPI: 1013015601
Provider Name (Legal Business Name): ADVANCED DYNAMICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 S LA BREA AVE SUITE 204
LOS ANGELES CA
90016-5354
US

IV. Provider business mailing address

3717 S LA BREA AVE SUITE 204
LOS ANGELES CA
90016-5354
US

V. Phone/Fax

Practice location:
  • Phone: 323-295-5836
  • Fax:
Mailing address:
  • Phone: 323-295-5836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MATTHEW REDDICK PERRY
Title or Position: CEE/OWNER
Credential: RPT
Phone: 323-295-5836