Healthcare Provider Details

I. General information

NPI: 1164041422
Provider Name (Legal Business Name): ADVANCED CARE MULTISPECIALTY MEDICAL GROUP APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ROLLING OAKS DR STE 130
THOUSAND OAKS CA
91361-1286
US

IV. Provider business mailing address

4000 CALLE TECATE STE 115
CAMARILLO CA
93012-5285
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-7775
  • Fax:
Mailing address:
  • Phone: 805-485-2400
  • Fax: 805-233-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: HASHIM A MAPARA
Title or Position: PRESIDENT
Credential: MD
Phone: 718-909-6580