Healthcare Provider Details

I. General information

NPI: 1548101975
Provider Name (Legal Business Name): ADVANCE CARE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18344 CLARK ST STE 205
TARZANA CA
91356-3575
US

IV. Provider business mailing address

18344 CLARK ST STE 205
TARZANA CA
91356-3575
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIO ROSENBERG
Title or Position: CEO
Credential: MD
Phone: 310-666-1234