=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356427009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED CARDIOVASCULAR MEDICAL ASSOCIATES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 10/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1022 MURRIETA BLVD
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-4111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-961-8920
-----------------------------------------------------
Fax | 925-961-8923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1022 MURRIETA BLVD
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-961-8920
-----------------------------------------------------
Fax | 925-961-8923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. VIVIANE M ABUDAYEH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-886-6878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------