MEDICARE: ADVANCE HEALTHMED INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3334959-0001-0	OTHER		BUSINESS LICENSE

General Provider Information

NPI Number	:	1568173623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE HEALTHMED INC

Provider Business Mailing Address
First Line	:	14532 FRIAR ST STE G
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-2358
Country	:	US
Telephone Number	:	818-290-3258
Fax Number	:

Provider Business Practice Location Address
First Line	:	14532 FRIAR ST STE G
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-2358
Country	:	US
Telephone Number	:	818-290-3258
Fax Number	:	818-290-3371

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	PETROS PATATANIAN
Credential	:
Telephone Number	:	818-290-3258

Provider Enumeration Date	:	12/09/2022
Last Update Date	:	12/09/2022

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Directions to “ADVANCE HEALTHMED INC ” Practice Location

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