ANTELOPE VALLEY COMMUNITY CLINIC (NPI# 1720537863) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720537863 |
| Entity Type | Organization |
| Organization Name | ANTELOPE VALLEY COMMUNITY CLINIC |
| Practice Address |
37926 47th St E Palmdale CA 93552-3272 |
| Mailing Address |
45104 10th St W Lancaster CA 93534-2310 |
| Practice Telephone | 6619422391 |
| Mailing Telephone | 6619422391 |
| Enumeration Date | 2016-09-30 |
| Last Update Date | 2017-06-01 |
| Authorized Official Name | JAMES COOK (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 6619422391 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
CA | Ambulatory Health Care Facilities |
| 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 |
| 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 |
| 1346563673 | Antelope Valley Community Clinic | Clinic/Center | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2010-03-01 |
| 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 |
37926 47TH ST E |
| City | PALMDALE |
| State | CA |
| Zip Code | 93552-3272 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538543384 | Erica Lynn Bell | Registered Nurse | 37926 47th St E, Palmdale, CA 93552-3272 | 2015-07-10 |
| 1255891875 | Jwch Institute, Inc. | Clinic/Center | 37926 47th St E, Palmdale, CA 93552-3272 | 2019-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164944732 | Juana Duran Ramos | Registered Nurse | 38350 40th St E., #100, Palmdale, CA 93552 | 2017-07-14 |
| 1801318282 | Fatima Cecile Smith | Registered Nurse | 38350 40th Street East, Palmdale, CA 93552 | 2017-07-07 |
| 1326423575 | Trieu & Kang Professional Dental Corp | Dentist | 38024 47th Street, Suite H, Palmdale, CA 93552 | 2015-07-29 |
| 1043623358 | James Juan Chang | Pharmacist | 37850 47th St E, Palmdale, CA 93552 | 2014-06-04 |
| 1164718128 | Ana Victoria Gomez | Driver | 38021 Lido Dr., Palmdale, CA 93552 | 2011-06-28 |
| 1700115342 | Song Kyun Kim | Dentist | 4635 E Avenue S, Ste C102-103, Palmdale, CA 93552 | 2009-12-10 |
| 1760512180 | Kelly A Graham Flores | Marriage & Family Therapist | 36003 40th St E, Pamdale, CA 93552 | 2007-03-06 |
| 1093246100 | Sona Galstian | Dentist | 38209 47th St E Ste E, Palmdale, CA 93552 | 2017-03-21 |
| 1528580248 | Ewuraba Abban | Registered Nurse | 38350 40th St E Ste 110, Palmdale, CA 93552-3075 | 2017-07-13 |
| 1922452382 | Emel Kasgarli | Clinic/Center | 38350 40th St E Ste 100, Palmdale, CA 93552-3075 | 2016-04-21 |
| Find all providers in zip 93552 | ||||
| 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 |
| 1346563673 | Antelope Valley Community Clinic | Clinic/Center | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2010-03-01 |
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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.