Basic Information
| Provider Information | |||||||||
| NPI: | 1386939379 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANTELOPE VALLEY HOSPITAL PHYSICIANS MEDICAL GROUP, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 W AVENUE J | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619495000 | ||||||||
| FaxNumber: | 6619514270 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 W AVENUE J | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619495000 | ||||||||
| FaxNumber: | 6619514270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2011 | ||||||||
| LastUpdateDate: | 06/17/2011 | ||||||||
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| AuthorizedOfficialLastName: | ARNAOUT | ||||||||
| AuthorizedOfficialFirstName: | WALID | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6619495000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 2086S0122X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 2086S0129X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208G00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.