Provider Demographics
NPI:1720076912
Name:AVOP-ANTELOPE VALLEY ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:AVOP-ANTELOPE VALLEY ORTHOTICS & PROSTHETICS
Other - Org Name:A.V.O.P.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PROSTHETIST ORTHOTIST
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JANOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:BOCOP, CPO
Authorized Official - Phone:661-267-0772
Mailing Address - Street 1:525 COMMERCE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4487
Mailing Address - Country:US
Mailing Address - Phone:661-267-0772
Mailing Address - Fax:661-267-6094
Practice Address - Street 1:525 COMMERCE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4487
Practice Address - Country:US
Practice Address - Phone:661-267-0772
Practice Address - Fax:661-267-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ39886ZOtherBLUE SHIELD
CAXC0153290Medicaid
CAZZZ39886ZOtherBLUE SHIELD