Provider Demographics
NPI:1730929175
Name:AMBER MEDICAL GROUP LLC
Entity type:Organization
Organization Name:AMBER MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-356-9778
Mailing Address - Street 1:165 S CLARENCE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-3303
Mailing Address - Country:US
Mailing Address - Phone:409-356-9778
Mailing Address - Fax:
Practice Address - Street 1:165 S CLARENCE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-3303
Practice Address - Country:US
Practice Address - Phone:409-356-9778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)