Provider Demographics
NPI:1285390278
Name:AVALOS, LETICIA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:AVALOS
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 1:832 E LYNDALE DR
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2932
Mailing Address - Country:US
Mailing Address - Phone:559-310-2027
Mailing Address - Fax:
Practice Address - Street 1:1645 E TULARE AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-3155
Practice Address - Country:US
Practice Address - Phone:559-688-5839
Practice Address - Fax:559-688-2470
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician