Provider Demographics
NPI:1588701304
Name:AVILA, ROSA LINDA (CPHW,MA)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:LINDA
Last Name:AVILA
Suffix:
Gender:F
Credentials:CPHW,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10454 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2444
Mailing Address - Country:US
Mailing Address - Phone:626-453-8466
Mailing Address - Fax:626-453-8465
Practice Address - Street 1:10454 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2444
Practice Address - Country:US
Practice Address - Phone:626-453-8466
Practice Address - Fax:626-453-8465
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70619FMedicare UPIN