Basic Information
| Provider Information | |||||||||
| NPI: | 1437475233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AVILA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | ROSS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26923 BRUCE RD | ||||||||
| Address2: | |||||||||
| City: | BAY VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441402210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193610588 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7007 POWERS BLVD | ||||||||
| Address2: | |||||||||
| City: | PARMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441295437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2406862300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2010 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34.015512 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 510109475 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | 2014041655 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.