1033304035 NPI number — ANTELOPE VALLEY ORTHOPAEDIC& REHABILIATION SPECIALISTS

Table of content: (NPI 1033304035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033304035 NPI number — ANTELOPE VALLEY ORTHOPAEDIC& REHABILIATION SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTELOPE VALLEY ORTHOPAEDIC& REHABILIATION SPECIALISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AVORS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033304035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44105 15TH ST W
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93534-4088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-726-5005
Provider Business Mailing Address Fax Number:
661-726-5377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44105 15TH ST W
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-4088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-726-5005
Provider Business Practice Location Address Fax Number:
661-726-5377
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
LYDIA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
661-726-5005

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  20A8954 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0000X , with the licence number: 20A8971 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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