| Av Occupational Medicine | |
|
42220 10th St W Ste 109 Lancaster CA 93534-7075 | |
| (661) 951-9195 | |
| Not Available |
| Full Name | Av Occupational Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 42220 10th St W, Lancaster, California |
| Authorized Official Name and Position | Jackie Bahlman (BILLER) |
| Authorized Official Contact | 6619519195 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Av Occupational Medicine 42220 10th St W Ste 109 Lancaster CA 93534-7075 Ph: (661) 951-9195 | Av Occupational Medicine 42220 10th St W Ste 109 Lancaster CA 93534-7075 Ph: (661) 951-9195 |
| NPI Number | 1982629853 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 02/18/2014 |
| Medicare PECOS PAC ID | 2668669102 |
|---|---|
| Medicare Enrollment ID | O20101209000221 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982629853 | NPI | - | NPPES |
| 00A549030 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A54903 (California) | Primary |
| Provider Name | Daniel O Mongiano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154436814 PECOS PAC ID: 9638366180 Enrollment ID: I20101209000290 |
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