Healthcare Provider Details

I. General information

NPI: 1699184085
Provider Name (Legal Business Name): ANTELOPE VALLEY LUNG INSTITUTE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20211 VALLEY BLVD
TEHACHAPI CA
93561-8751
US

IV. Provider business mailing address

20211 VALLEY BLVD.
TEHACHAPI CA
93561-8751
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-8717
  • Fax:
Mailing address:
  • Phone: 661-945-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SYED SAJEEL AHMED
Title or Position: OWNER/PARTNER
Credential:
Phone: 661-945-8717