Provider Demographics
NPI:1265170765
Name:AVIDA HEALTH SYSTEMS INC
Entity type:Organization
Organization Name:AVIDA HEALTH SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JURO CHRIST
Authorized Official - Middle Name:ENRIQUEZ
Authorized Official - Last Name:ADEFUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-552-7775
Mailing Address - Street 1:222 N MOUNTAIN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5714
Mailing Address - Country:US
Mailing Address - Phone:909-333-7133
Mailing Address - Fax:909-236-7989
Practice Address - Street 1:222 N MOUNTAIN AVE STE 205
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5714
Practice Address - Country:US
Practice Address - Phone:909-333-7133
Practice Address - Fax:909-236-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty