Provider Demographics
NPI:1043657638
Name:AFC OF AVONDALE, PLLC
Entity Type:Organization
Organization Name:AFC OF AVONDALE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:623-882-0600
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-943-4180
Mailing Address - Fax:
Practice Address - Street 1:210 N AVONDALE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-6905
Practice Address - Country:US
Practice Address - Phone:623-882-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFC OF AVONDALE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-23
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site