Basic Information
| Provider Information | |||||||||
| NPI: | 1730630427 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANTELOPE VALLEY COMMUNITY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45104 10TH ST W | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619422391 | ||||||||
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| Practice Location | |||||||||
| Address1: | 45124 10TH ST W | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619422391 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2016 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | COOK | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6619422391 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | 10016685 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.