Healthcare Provider Details

I. General information

NPI: 1003819194
Provider Name (Legal Business Name): ADVANCED INFUSION SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E DANA ST SUITE A
MOUNTAIN VIEW CA
94041-1507
US

IV. Provider business mailing address

3802 CORPOREX PARK DR STE 200
TAMPA FL
33619-1125
US

V. Phone/Fax

Practice location:
  • Phone: 650-961-6355
  • Fax: 650-969-5653
Mailing address:
  • Phone: 813-318-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPHY 48702
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY 48702
License Number StateCA

VIII. Authorized Official

Name: MR. THOMAS A. CANERIS
Title or Position: VICE PRESIDENT
Credential:
Phone: 502-627-7100