Healthcare Provider Details

I. General information

NPI: 1366060899
Provider Name (Legal Business Name): AVINA HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 ELLINGTON ST
DELANO CA
93215-2621
US

IV. Provider business mailing address

1017 ELLINGTON ST
DELANO CA
93215-2621
US

V. Phone/Fax

Practice location:
  • Phone: 661-427-4612
  • Fax:
Mailing address:
  • Phone: 661-425-7107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN KOMOTO
Title or Position: CEO
Credential: PHARMD
Phone: 661-427-4612