Provider Demographics
NPI:1497530075
Name:BETHAL, AUNDRIA JOI
Entity Type:Individual
Prefix:
First Name:AUNDRIA
Middle Name:JOI
Last Name:BETHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15095 ARMARGOSA RD. SUITE 201
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394
Mailing Address - Country:US
Mailing Address - Phone:760-245-4695
Mailing Address - Fax:760-513-4696
Practice Address - Street 1:15095 ARMARGOSA RD. SUITE 201
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394
Practice Address - Country:US
Practice Address - Phone:760-245-4695
Practice Address - Fax:760-513-4696
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker