Avida Health Systems Inc

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

AVIDA HEALTH SYSTEMS INC

Practice address

222 N Mountain Ave Ste 205
Upland, CA 91786-5714

Phone

(909) 333-7133

Fax

(909) 236-7989

NPI assigned

May 24, 2022

Last updated

May 24, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Juro Christ Enriquez Adefuin

Title

Ceo

Phone

(562) 552-7775

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael K. Wensley, M.D.

  • Specialist
  • West Hollywood, CA
  • NPI 1841336740
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653350400000",
    "number": "1265170765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 N MOUNTAIN AVE STE 205",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917865714",
            "telephone_number": "909-333-7133",
            "fax_number": "909-236-7989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 N MOUNTAIN AVE STE 205",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917865714",
            "telephone_number": "909-333-7133",
            "fax_number": "909-236-7989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVIDA HEALTH SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-24",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A",
        "authorized_official_last_name": "ADEFUIN",
        "authorized_official_first_name": "JURO CHRIST",
        "authorized_official_middle_name": "ENRIQUEZ",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-552-7775",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.officeally.com",
            "affiliation": "N",
            "endpointDescription": "Electric Health Records",
            "address_1": "222 N Mountain Ave Ste 205",
            "city": "Upland",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917865714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Primary Care Nurse Practitioner in Upland, CA
• Providers in Upland, CA by specialty
• Primary Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.