Healthcare Provider Details

I. General information

NPI: 1750528170
Provider Name (Legal Business Name): ADVANCED MEDICAL HOME PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 AVENIDA PICO # C 517
SAN CLEMENTE CA
92673-6957
US

IV. Provider business mailing address

1001 AVENIDA PICO # C 517
SAN CLEMENTE CA
92673-6957
US

V. Phone/Fax

Practice location:
  • Phone: 949-226-8416
  • Fax: 949-226-8019
Mailing address:
  • Phone: 949-226-8416
  • Fax: 877-223-5602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA81573
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA64412
License Number StateCA

VIII. Authorized Official

Name: MICHAEL D HAGA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-226-8416