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General NPI Number Information
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NPI Number | 1588893366
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Entity Type | Organization
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Legal Business Name | ADVANCED MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 10/22/2011
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Provider Practice Location Address
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Address Line | 1001 W 16TH ST
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City | YUMA
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State | AZ
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Zip | 85364-4547
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Country | US
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Telephone | 928-782-0898
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Fax |
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Provider Business Mailing Address
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Address Line | 3442 W 14TH ST
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City | YUMA
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State | AZ
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Zip | 85364-4181
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. LOC HOANG NGUYEN
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Credential | MD
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Telephone | 602-345-1323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 35957
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License Number State | AZ
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