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General NPI Number Information
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NPI Number | 1366060899
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Entity Type | Organization
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Legal Business Name | AVINA HEALTH, INC
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 1017 ELLINGTON ST
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City | DELANO
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State | CA
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Zip | 93215-2621
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Country | US
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Telephone | 661-427-4612
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 ELLINGTON ST
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City | DELANO
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State | CA
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Zip | 93215-2621
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Country | US
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Telephone | 661-425-7107
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KEVIN KOMOTO
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Credential | PHARMD
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Telephone | 661-427-4612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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