Provider Demographics
NPI:1043631526
Name:AVANTGARDE MEDICAL, INC
Entity type:Organization
Organization Name:AVANTGARDE MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YURY
Authorized Official - Middle Name:
Authorized Official - Last Name:FURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-556-3470
Mailing Address - Street 1:4601 WILSHIRE BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3884
Mailing Address - Country:US
Mailing Address - Phone:323-556-3470
Mailing Address - Fax:
Practice Address - Street 1:4601 WILSHIRE BLVD FL 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3884
Practice Address - Country:US
Practice Address - Phone:323-556-3470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Multi-Specialty