| Organization Name: | AVALON MEDICAL GROUP OF WHITTIER INC. |
| NPI Number: | 1003039132 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE PENN (COMPLIANCE OFFICER) |
| Mailing Address: | 16030 Ventura Blvd Ste 200 Encino |
| State: | CA US |
| Postal Code: | 914362754 |
| Phone Number: | 8184615030 |
| Fax Number: | 8184615095 |
| NPI Enumeration Date: | 04/10/2007 |
| NPI Last Update Date: | 07/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | A33793 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |