Provider Demographics
NPI:1114287224
Name:AVILA, MIGUEL ANGELO (AUD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGELO
Last Name:AVILA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 LONG BEACH BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4023
Mailing Address - Country:US
Mailing Address - Phone:323-524-4523
Mailing Address - Fax:562-989-8119
Practice Address - Street 1:3605 LONG BEACH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4023
Practice Address - Country:US
Practice Address - Phone:323-524-4523
Practice Address - Fax:562-989-8119
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2824231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist