Provider Demographics
NPI:1245765056
Name:AVILA, NORA JASMIN
Entity Type:Individual
Prefix:MISS
First Name:NORA
Middle Name:JASMIN
Last Name:AVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31812 RIDGE BERRY DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8631
Mailing Address - Country:US
Mailing Address - Phone:951-219-0031
Mailing Address - Fax:
Practice Address - Street 1:31812 RIDGE BERRY DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-8631
Practice Address - Country:US
Practice Address - Phone:951-219-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-29
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-16-21906106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician