Provider Demographics
NPI:1225792922
Name:AVALOS, DESTINY F (MA)
Entity Type:Individual
Prefix:MS
First Name:DESTINY
Middle Name:F
Last Name:AVALOS
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:A CHANGE IN TRAJECTORY
Mailing Address - Street 2:5415 AVENIDA DE LOS ROBLES STE 102
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291
Mailing Address - Country:US
Mailing Address - Phone:559-372-2009
Mailing Address - Fax:
Practice Address - Street 1:A CHANGE IN TRAJECTORY
Practice Address - Street 2:5415 AVENIDA DE LOS ROBLES STE 102
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-372-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician