Healthcare Provider Details

I. General information

NPI: 1659022457
Provider Name (Legal Business Name): AUTREY INSURANCE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 ROCK LN
LA VERNE CA
91750-2611
US

IV. Provider business mailing address

1867 ROCK LN
LA VERNE CA
91750-2611
US

V. Phone/Fax

Practice location:
  • Phone: 909-331-7318
  • Fax: 626-935-9884
Mailing address:
  • Phone: 909-331-7318
  • Fax: 626-935-9884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MAUICE LYDELL AUTREY
Title or Position: OWNER
Credential:
Phone: 909-331-7318