Provider Demographics
NPI:1639460637
Name:HERBRICK, AVA S (CPO)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:S
Last Name:HERBRICK
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 21ST STREET
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4002
Mailing Address - Country:US
Mailing Address - Phone:661-322-1005
Mailing Address - Fax:661-322-0528
Practice Address - Street 1:23033 LYONS AVE
Practice Address - Street 2:STE 6
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2727
Practice Address - Country:US
Practice Address - Phone:661-253-1191
Practice Address - Fax:661-253-1343
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO1844222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist