ANTELOPE VALLEY COMMUNITY CLINIC (NPI# 1346563673) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346563673 |
| Entity Type | Organization |
| Organization Name | ANTELOPE VALLEY COMMUNITY CLINIC |
| Other Organization Name | ANTELOPE VALLEY COMMUNITY CLINIC-PALMDALE |
| Practice Address |
2151 E Palmdale Blvd Palmdale CA 93550-4037 |
| Mailing Address |
45074 10th Street West Suite 109 Lancaster CA 93534-2382 |
| Practice Telephone | 6615750009 |
| Practice Fax Number | 6615750015 |
| Mailing Telephone | 6615750009 |
| Mailing Fax Number | 6615750015 |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2011-07-06 |
| Authorized Official Name | MR. JAMES A. COOK (CEO) |
| Authorized Official Telephone | 6619422391 |
| Is Organization Subpart | Y |
| Parent Organization Name | ANTELOPE VALLEY COMMUNITY CLINIC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
550001129 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICARE PTAN | CT556A | 01 |
| Other Name | Type Code |
|---|---|
| Antelope Valley Community Clinic-Palmdale | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154840320 | Antelope Valley Community Clinic | Substance Abuse Rehabilitation Facility | 502 Sugar Loaf Dr, Palmdale, CA 93551-7953 | 2017-09-19 |
| 1730630427 | Antelope Valley Community Clinic | Clinic/Center | 45124 10th St W, Lancaster, CA 93534-2310 | 2016-10-18 |
| 1811448293 | Antelope Valley Community Clinic | Clinic/Center | 45124 10th St W, Lancaster, CA 93534-2310 | 2016-10-20 |
| 1720537863 | Antelope Valley Community Clinic | Clinic/Center | 37926 47th St E, Palmdale, CA 93552-3272 | 2016-09-30 |
| 1245690387 | Antelope Valley Community Clinic | Clinic/Center | 45104 10th St W, Lancaster, CA 93534-2310 | 2016-03-02 |
| 1730499872 | Antelope Valley Community Clinic | Clinic/Center | 45104 10th St W, Lancaster, CA 93534-2310 | 2010-10-07 |
| 1619290624 | Antelope Valley Community Clinic | Clinic/Center | 45104 10th St W, Lancaster, CA 93534-2310 | 2010-03-04 |
| 1609199934 | Antelope Valley Community Clinic | Clinic/Center | 44216 10th St W, Lancaster, CA 93534-4134 | 2010-03-01 |
| 1710199674 | Antelope Valley Community Clinic | Clinic/Center | 45104 10th St W, Lancaster, CA 93534-2310 | 2007-05-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ANTELOPE VALLEY COMMUNITY CLINIC | 45104 10th St W, Lancaster, CA 93534-2310 |
| Street Address |
2151 E PALMDALE BLVD |
| City | PALMDALE |
| State | CA |
| Zip Code | 93550-4037 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164403929 | Manouchehr Khandadash | Pediatrics | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2005-11-09 |
| 1902455827 | Sandy Pena | Social Worker | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2019-09-04 |
| 1477106557 | Bran'd Hutalla | Dentist | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2019-07-18 |
| 1780144303 | Jwch Institute, Inc. | Clinic/Center | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2019-03-20 |
| 1700337268 | Adrianne Fletcher | Dental Hygienist | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2016-10-19 |
| 1174998322 | Marigold Rose Almoradie Reyes | Dentist | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2015-12-13 |
| 1396142956 | Helen Chioma Okoh | Internal Medicine | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2014-11-25 |
| 1689957896 | Luisa M Jenkins | Dental Hygienist | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2011-09-23 |
| 1144511668 | Paul Edward Round | Pediatrics | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2011-05-02 |
| 1275847436 | Diane Elizabeth Bite | Nurse Practitioner | 2151 E Palmdale Blvd, Palmdale, CA 93550-1831 | 2010-07-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922612118 | Well Care Hospice Inc | Hospice Care, Community Based | 1543j East Palmdale Blvd., Palmdale, CA 93550 | 2020-09-03 |
| 1922565522 | California Recuperative Care, Inc | Social Worker | 38529 6th St. East, Palmdale, CA 93550 | 2019-03-01 |
| 1649751777 | Earl Larry Hernandez | Rehabilitation Practitioner | 1609 East Palmdale Blvd Suite G, Palmdale, CA 93550 | 2018-08-27 |
| 1265940050 | Virginia Alvarez | Counselor | 3058 East Aver14, Palmdale, CA 93550 | 2018-01-16 |
| 1225553498 | Natalie Christine Ragus | Social Worker | 1529 E. Palmdale Blvd. Ste 150, Palmdale, CA 93550 | 2017-08-09 |
| 1104348770 | Purificacion Paguyo Villegas | Registered Nurse | 38350 40th St East, 2nd Floor, Palmdale, CA 93550 | 2017-07-14 |
| 1528580438 | Perla Marilyn Rodriguez | Registered Nurse | 38350 40th St East, Palmdale, CA 93550 | 2017-07-12 |
| 1992259527 | Nathalie Exconde | Counselor | 1529 East Palmdale Blvd Suite 150, Palmdale, CA 93550 | 2016-08-11 |
| 1083064604 | Sinead Diaz | Community Health Worker | 2323a East Palmdale Boulvard, Palmdale, CA 93550 | 2016-06-14 |
| 1598122293 | Sharnelle Denise Patterson | Rehabilitation Practitioner | 2010 Moonflower Ct, Palmdale, CA 93550 | 2016-01-26 |
| Find all providers in zip 93550 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720619828 | Margarita Humanitarian Foundation | Clinic/Center | 1543 E Palmdale Blvd Ste D, Palmdale, CA 93550-2000 | 2020-01-28 |
| 1720537863 | Antelope Valley Community Clinic | Clinic/Center | 37926 47th St E, Palmdale, CA 93552-3272 | 2016-09-30 |
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| 1134727746 | Golden Valley Health Center | Clinic/Center | 1524 Mchenry Ave Ste 565, Modesto, CA 95350-4500 | 2020-10-15 |
| 1083221451 | Harmony Health Medical Clinic and Family Resource Center | Clinic/Center | 1930 N. Beale Road, Marysville, CA 95901-6915 | 2020-09-29 |
| 1235745928 | Community Medical Centers Inc | Clinic/Center | 747 E Channel St, Stockton, CA 95202-2628 | 2020-09-18 |
| 1760098503 | Chicago Clinica Medica Familiar Operated By Neighborhood Healthcare | Clinic/Center | 4022 Chicago Ave Ste A, Riverside, CA 92507-5340 | 2020-09-17 |
| 1164037149 | Camarena Health | Clinic/Center | 16645 Road 26, Madera, CA 93638-0830 | 2020-09-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.