Provider Demographics
NPI:1427161967
Name:AVILA, CYNTHIA YVONNE (DPM)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:YVONNE
Last Name:AVILA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:OLVERA
Other - Last Name:AVILA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1755 W PRICE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8602
Mailing Address - Country:US
Mailing Address - Phone:956-546-1000
Mailing Address - Fax:956-504-9808
Practice Address - Street 1:1755 W. PRICE RD.
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6339
Practice Address - Country:US
Practice Address - Phone:956-546-1000
Practice Address - Fax:956-504-9808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1508213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140700901Medicaid
TX680506998Medicare UPIN
TXU82502Medicare UPIN
TX140700901Medicaid