Provider Demographics
NPI:1871804484
Name:ADVANCED MEDICAL PSYCHIATRIC SERVICES
Entity type:Organization
Organization Name:ADVANCED MEDICAL PSYCHIATRIC SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-589-1200
Mailing Address - Street 1:3409 CALLOWAY DR
Mailing Address - Street 2:SUITE #601
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2528
Mailing Address - Country:US
Mailing Address - Phone:661-589-1200
Mailing Address - Fax:661-589-7200
Practice Address - Street 1:3409 CALLOWAY DR UNIT 601
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2534
Practice Address - Country:US
Practice Address - Phone:661-589-1200
Practice Address - Fax:661-589-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF23012Medicare UPIN