Provider Demographics
NPI:1083736995
Name:AVILA PAIN AND WELLNESS CENTER, PA
Entity Type:Organization
Organization Name:AVILA PAIN AND WELLNESS CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-554-7733
Mailing Address - Street 1:1100 N EXPRESSWAY 83
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521
Mailing Address - Country:US
Mailing Address - Phone:956-504-3200
Mailing Address - Fax:
Practice Address - Street 1:1100 N EXPRESSWAY 83
Practice Address - Street 2:SUITE 3
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521
Practice Address - Country:US
Practice Address - Phone:956-504-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00930ZMedicare ID - Type Unspecified
TXE77092Medicare UPIN