Provider Demographics
NPI:1497171748
Name:ADVANCE CARE SPECIALIST MEDICAL CLINIC
Entity type:Organization
Organization Name:ADVANCE CARE SPECIALIST MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHILLING
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:562-997-7996
Mailing Address - Street 1:7851 MISSION CENTER CT STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1327
Mailing Address - Country:US
Mailing Address - Phone:619-291-5410
Mailing Address - Fax:619-291-5412
Practice Address - Street 1:7851 MISSION CENTER CT STE 205
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1327
Practice Address - Country:US
Practice Address - Phone:619-291-5410
Practice Address - Fax:619-291-5412
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCE CARE SPECIALIST MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60661261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine