Healthcare Provider Details

I. General information

NPI: 1639460637
Provider Name (Legal Business Name): AVA S HERBRICK C.P.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23033 LYONS AVE STE 6
NEWHALL CA
91321-2727
US

IV. Provider business mailing address

1524 21ST STREET
BAKERSFIELD CA
93301-4002
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-1191
  • Fax: 661-253-1343
Mailing address:
  • Phone: 661-322-1005
  • Fax: 661-322-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO1844
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO1844
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: