Provider Demographics
NPI:1700394913
Name:KLER, AVTAR S
Entity Type:Individual
Prefix:
First Name:AVTAR
Middle Name:S
Last Name:KLER
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 1:3924 RHAPSODY CT
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4830
Mailing Address - Country:US
Mailing Address - Phone:916-380-2655
Mailing Address - Fax:
Practice Address - Street 1:3924 RHAPSODY CT
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-4830
Practice Address - Country:US
Practice Address - Phone:916-380-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN277296164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse