Healthcare Provider Details

I. General information

NPI: 1629691209
Provider Name (Legal Business Name): ANTELOPE VALLEY NEONATOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44155 15TH ST W
LANCASTER CA
93534-4079
US

IV. Provider business mailing address

220 STANDIFORD AVE STE F
MODESTO CA
95350-1159
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-5366
  • Fax: 661-949-5039
Mailing address:
  • Phone: 209-579-5628
  • Fax: 209-579-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MURUGESAMUDALIAR THANGAVEL
Title or Position: PARTNER
Credential: MD
Phone: 661-400-6577