Provider Demographics
NPI:1376727867
Name:AV INSTITUTE OF ORTHOPEDICS INC
Entity Type:Organization
Organization Name:AV INSTITUTE OF ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRAJULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-940-6411
Mailing Address - Street 1:5558 BIENVENEDA TER
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5728
Mailing Address - Country:US
Mailing Address - Phone:661-940-6411
Mailing Address - Fax:661-940-6497
Practice Address - Street 1:5558 BIENVENEDA TER
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-5728
Practice Address - Country:US
Practice Address - Phone:661-940-6411
Practice Address - Fax:661-940-6497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51163261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty