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General NPI Number Information
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NPI Number | 1356765655
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Entity Type | Organization
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Legal Business Name | ANTELOPE VALLEY LUNG INSTITUTE MEDICAL GROUP
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Dates
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Enumeration Date | 02/07/2014
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 44105 15TH ST W 303
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City | LANCASTER
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State | CA
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Zip | 93534-4089
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Country | US
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Telephone | 661-945-8717
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Fax | 661-945-1118
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Provider Business Mailing Address
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Address Line | 44105 15TH ST W SUITE 303
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City | LANCASTER
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State | CA
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Zip | 93534-4088
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Country | US
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Telephone | 661-945-8717
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Fax | 661-945-1118
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. SYED SAJEEL AHMED
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Credential |
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Telephone | 661-945-8717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A87434
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License Number State | CA
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