Provider Demographics
NPI:1164846804
Name:AVILA, ANGELINA MARIA (LICENSED VOCATIONAL)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:MARIA
Last Name:AVILA
Suffix:
Gender:F
Credentials:LICENSED VOCATIONAL
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:MARIA
Other - Last Name:HARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:CRITTENTON SERVICES
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92836-0919
Mailing Address - Country:US
Mailing Address - Phone:714-680-8268
Mailing Address - Fax:714-680-8233
Practice Address - Street 1:801 E CHAPMAN AVE
Practice Address - Street 2:#203
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3839
Practice Address - Country:US
Practice Address - Phone:714-680-8268
Practice Address - Fax:714-680-8233
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268846164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse