Healthcare Provider Details

I. General information

NPI: 1306479365
Provider Name (Legal Business Name): AVANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 VETERAN AVE
LOS ANGELES CA
90064-4239
US

IV. Provider business mailing address

2743 VETERAN AVE
LOS ANGELES CA
90064-4239
US

V. Phone/Fax

Practice location:
  • Phone: 424-625-8210
  • Fax:
Mailing address:
  • Phone: 310-980-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA LEE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MA, OTR/L
Phone: 310-980-4066