Provider Demographics
NPI:1174178446
Name:AVILA, ALEJANDRO VARGAS
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:VARGAS
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 1:405 LITTLE SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-1861
Mailing Address - Country:US
Mailing Address - Phone:407-714-6926
Mailing Address - Fax:
Practice Address - Street 1:405 LITTLE SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-1861
Practice Address - Country:US
Practice Address - Phone:407-714-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver