Healthcare Provider Details

I. General information

NPI: 1346965399
Provider Name (Legal Business Name): AVPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 BARTON RD
REDLANDS CA
92373-5308
US

IV. Provider business mailing address

4016 GRAND AVE STE A-1062
CHINO CA
91710-5491
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-1382
  • Fax: 909-308-1101
Mailing address:
  • Phone: 626-523-8956
  • Fax: 626-657-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE TAPANG DITULLIO
Title or Position: CO-MANAGER
Credential:
Phone: 626-523-8956