Healthcare Provider Details

I. General information

NPI: 1588522254
Provider Name (Legal Business Name): AVA ROSE DVORAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E ROWLAND ST
COVINA CA
91723-3147
US

IV. Provider business mailing address

155 BIMINI PL
LOS ANGELES CA
90004-5902
US

V. Phone/Fax

Practice location:
  • Phone: 213-388-5423
  • Fax: 213-388-5423
Mailing address:
  • Phone: 213-388-5423
  • Fax: 213-388-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: