Healthcare Provider Details

I. General information

NPI: 1033304035
Provider Name (Legal Business Name): ANTELOPE VALLEY ORTHOPAEDIC& REHABILIATION SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44105 15TH ST W SUITE 201
LANCASTER CA
93534-4088
US

IV. Provider business mailing address

44105 15TH ST W SUITE 201
LANCASTER CA
93534-4088
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 TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number20A8971
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A8954
License Number StateCA

VIII. Authorized Official

Name: LYDIA N BAKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 661-726-5005