Provider Demographics
NPI:1063028348
Name:AVILA, KENDALL MARIE (MA)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:MARIE
Last Name:AVILA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 PUEBLO VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2159
Mailing Address - Country:US
Mailing Address - Phone:559-408-8103
Mailing Address - Fax:
Practice Address - Street 1:28 PUEBLO VISTA RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2159
Practice Address - Country:US
Practice Address - Phone:559-408-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other