Provider Demographics
NPI:1275592867
Name:AV PEDIATRICS MEDICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:AV PEDIATRICS MEDICAL ASSOCIATES INC.
Other - Org Name:AV PEDIATRICS, ALLERGY & FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENET
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANGJAHR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, PA
Authorized Official - Phone:661-945-2221
Mailing Address - Street 1:1523 W AVENUE J
Mailing Address - Street 2:SUITE #7
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2819
Mailing Address - Country:US
Mailing Address - Phone:661-945-2221
Mailing Address - Fax:661-945-0831
Practice Address - Street 1:1523 W AVENUE J
Practice Address - Street 2:SUITE #7
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2819
Practice Address - Country:US
Practice Address - Phone:661-945-2221
Practice Address - Fax:661-945-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15481Medicare ID - Type Unspecified