Provider Demographics
NPI:1033872023
Name:AVILA, DARIO
Entity Type:Individual
Prefix:
First Name:DARIO
Middle Name:
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 1:12007 RESEARCH BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2429
Mailing Address - Country:US
Mailing Address - Phone:737-708-1117
Mailing Address - Fax:
Practice Address - Street 1:9309 MAGNOLIA RANCH CV
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-8932
Practice Address - Country:US
Practice Address - Phone:512-815-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2022-07-27
Deactivation Date:2021-10-18
Deactivation Code:
Reactivation Date:2022-06-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0657405-01Medicaid
TX065740501Medicaid