Healthcare Provider Details

I. General information

NPI: 1023297165
Provider Name (Legal Business Name): AVORS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42135 10TH ST W STE 101
LANCASTER CA
93534-7099
US

IV. Provider business mailing address

42135 10TH ST W STE 101
LANCASTER CA
93534-7099
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-5005
  • Fax: 661-726-5377
Mailing address:
  • Phone: 661-726-5005
  • Fax: 661-726-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A8971
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A8954
License Number StateCA

VIII. Authorized Official

Name: ALON ANTEBI
Title or Position: PRESIDENT
Credential: D.O.
Phone: 661-726-5005