Provider Demographics
NPI:1306015912
Name:AVILEZ, HERMAN (MA (CSULA))
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:
Last Name:AVILEZ
Suffix:
Gender:M
Credentials:MA (CSULA)
Other - Prefix:MR
Other - First Name:HERMAN
Other - Middle Name:
Other - Last Name:AVILEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFICATION DRUG
Mailing Address - Street 1:2568 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5055
Mailing Address - Country:US
Mailing Address - Phone:323-440-0733
Mailing Address - Fax:323-722-4450
Practice Address - Street 1:3316 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-1537
Practice Address - Country:US
Practice Address - Phone:323-722-4529
Practice Address - Fax:323-722-4450
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251B00000XAgenciesCase Management