Provider Demographics
NPI:1578279501
Name:AVINA, JOHN BROWN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BROWN
Last Name:AVINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37223 QUEEN ANNE PL
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-6905
Mailing Address - Country:US
Mailing Address - Phone:661-714-7381
Mailing Address - Fax:
Practice Address - Street 1:37223 QUEEN ANNE PL
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-6905
Practice Address - Country:US
Practice Address - Phone:661-714-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No372600000XNursing Service Related ProvidersAdult Companion