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 1:400 OYSTER POINT BLVD STE 501
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7600
Mailing Address - Country:US
Mailing Address - Phone:650-866-4080
Mailing Address - Fax:650-866-4083
Practice Address - Street 1:3360 N HIGHWAY 59 STE K
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-9405
Practice Address - Country:US
Practice Address - Phone:209-726-3090
Practice Address - Fax:209-722-7648
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator