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General NPI Number Information
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NPI Number | 1174346498
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Entity Type | Organization
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Legal Business Name | ADVANCED MANAGEMENT PRACTICE PHYSICIAN ASSISTANT CORPORATION
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 41715 WINCHESTER RD STE 107
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City | TEMECULA
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State | CA
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Zip | 92590-4853
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Country | US
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Telephone | 951-501-0049
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Fax | 833-585-1122
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Provider Business Mailing Address
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Address Line | 4225 EXECUTIVE SQ STE 600 PMB6042
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City | LA JOLLA
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State | CA
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Zip | 92037
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Country | US
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Telephone | 760-400-6375
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Fax | 858-216-8050
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALLEN MARTIN PHELPS
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Credential | PA-C
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Telephone | 760-400-6375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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