Basic Information
| Provider Information | |||||||||
| NPI: | 1982295226 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AVILA | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 COLORADO BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900411744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235432800 | ||||||||
| FaxNumber: | 3239781263 | ||||||||
| Practice Location | |||||||||
| Address1: | 9828 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | MONTCLAIR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917632817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094477520 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2021 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.