Provider Demographics
NPI:1659022457
Name:AUTREY INSURANCE AGENCY
Entity Type:Organization
Organization Name:AUTREY INSURANCE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUICE
Authorized Official - Middle Name:LYDELL
Authorized Official - Last Name:AUTREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-331-7318
Mailing Address - Street 1:1867 ROCK LN
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2611
Mailing Address - Country:US
Mailing Address - Phone:909-331-7318
Mailing Address - Fax:626-935-9884
Practice Address - Street 1:1867 ROCK LN
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2611
Practice Address - Country:US
Practice Address - Phone:909-331-7318
Practice Address - Fax:626-935-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care