Provider Demographics
NPI:1427828847
Name:AVILA, LUIS CARLOS
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:CARLOS
Last Name:AVILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 W WEBER AVE STE 128C
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-3146
Mailing Address - Country:US
Mailing Address - Phone:209-265-3149
Mailing Address - Fax:
Practice Address - Street 1:445 W WEBER AVE STE 128C
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-3146
Practice Address - Country:US
Practice Address - Phone:209-265-3149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner