Provider Demographics
NPI:1881070100
Name:AV BEHAVIORAL MEDICINE, INC
Entity type:Organization
Organization Name:AV BEHAVIORAL MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARITES
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-726-2949
Mailing Address - Street 1:1672 W AVENUE J
Mailing Address - Street 2:110
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2827
Mailing Address - Country:US
Mailing Address - Phone:661-723-9557
Mailing Address - Fax:
Practice Address - Street 1:1672 W AVENUE J STE 110
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2859
Practice Address - Country:US
Practice Address - Phone:661-723-9557
Practice Address - Fax:661-347-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA535702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty