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General NPI Number Information
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NPI Number | 1306727599
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Entity Type | Organization
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Legal Business Name | ANTELOPE VALLEY PRIMARY CARE
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1331 W AVENUE J STE 101
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City | LANCASTER
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State | CA
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Zip | 93534-2942
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Country | US
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Telephone | 661-414-7016
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Fax |
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Provider Business Mailing Address
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Address Line | 1331 W AVENUE J STE 101
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City | LANCASTER
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State | CA
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Zip | 93534-2942
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Country | US
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Telephone | 661-414-7016
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. VINCENT M ESTACIO
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Credential | RN
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Telephone | 661-673-3204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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