Provider Demographics
NPI:1114799178
Name:AV BRIDGES MENTAL HEALTH CORP
Entity Type:Organization
Organization Name:AV BRIDGES MENTAL HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-310-3110
Mailing Address - Street 1:1331 W. AVE J
Mailing Address - Street 2:UNIT 101A
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-310-3110
Mailing Address - Fax:661-310-3112
Practice Address - Street 1:1331 W. AVE J
Practice Address - Street 2:UNIT 101A
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-310-3110
Practice Address - Fax:661-310-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty