Provider Demographics
NPI:1366039612
Name:AV PHYSICIAN'S GROUP, INC
Entity Type:Organization
Organization Name:AV PHYSICIAN'S GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVIL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:415-216-6415
Mailing Address - Street 1:3580 SANTA ANITA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2455
Mailing Address - Country:US
Mailing Address - Phone:415-216-6415
Mailing Address - Fax:
Practice Address - Street 1:3580 SANTA ANITA AVE STE B
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2455
Practice Address - Country:US
Practice Address - Phone:415-216-6415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AV PHYSICIAN'S GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty