Provider Demographics
NPI:1366215642
Name:AMADA CYNTHIA AVILA
Entity type:Organization
Organization Name:AMADA CYNTHIA AVILA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMADA
Authorized Official - Middle Name:CYNTHIA
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-748-5039
Mailing Address - Street 1:1622 PASEO CARINA UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1755
Mailing Address - Country:US
Mailing Address - Phone:619-748-5039
Mailing Address - Fax:
Practice Address - Street 1:AVE MARMOL #12
Practice Address - Street 2:EL RUBI
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22630
Practice Address - Country:MX
Practice Address - Phone:619-748-5039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty