Provider Demographics
NPI:1033304035
Name:ANTELOPE VALLEY ORTHOPAEDIC& REHABILIATION SPECIALISTS
Entity Type:Organization
Organization Name:ANTELOPE VALLEY ORTHOPAEDIC& REHABILIATION SPECIALISTS
Other - Org Name:AVORS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-726-5005
Mailing Address - Street 1:44105 15TH ST W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4088
Mailing Address - Country:US
Mailing Address - Phone:661-726-5005
Mailing Address - Fax:661-726-5377
Practice Address - Street 1:44105 15TH ST W
Practice Address - Street 2:SUITE 201
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4088
Practice Address - Country:US
Practice Address - Phone:661-726-5005
Practice Address - Fax:661-726-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8954207X00000X
CA20A8971208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty