Provider Demographics
NPI:1063899615
Name:AVILA, CAMILA (MD)
Entity type:Individual
Prefix:
First Name:CAMILA
Middle Name:
Last Name:AVILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 MEMORIAL HWY STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4564
Mailing Address - Country:US
Mailing Address - Phone:813-514-2328
Mailing Address - Fax:813-514-2485
Practice Address - Street 1:6107 MEMORIAL HWY STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4564
Practice Address - Country:US
Practice Address - Phone:813-514-2328
Practice Address - Fax:813-514-2485
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129513207Q00000X
FL129513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty