Provider Demographics
NPI:1215141015
Name:XIONG, AVA
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5856 PARK AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6892
Mailing Address - Country:US
Mailing Address - Phone:530-301-7988
Mailing Address - Fax:
Practice Address - Street 1:6117 MARYSVILLE RD
Practice Address - Street 2:
Practice Address - City:BROWNS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95918-9703
Practice Address - Country:US
Practice Address - Phone:530-301-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator