Provider Demographics
NPI:1114287224
Name:AVILA, MIGUEL ANGELO (AUD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGELO
Last Name:AVILA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 HUGHES AVE
Mailing Address - Street 2:600-B
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6843
Mailing Address - Country:US
Mailing Address - Phone:310-559-4884
Mailing Address - Fax:310-204-3175
Practice Address - Street 1:3831 HUGHES AVE.
Practice Address - Street 2:600-B
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6843
Practice Address - Country:US
Practice Address - Phone:310-559-4884
Practice Address - Fax:310-204-3175
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2824231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist