Provider Demographics
NPI:1245945773
Name:AVINA, OLAF BROWN
Entity type:Individual
Prefix:MR
First Name:OLAF
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:PO BOX 900242
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93590-0242
Mailing Address - Country:US
Mailing Address - Phone:661-492-8588
Mailing Address - Fax:
Practice Address - Street 1:37223 QUEEN ANNE PLACE
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:661-492-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider