Provider Demographics
NPI:1306821566
Name:AVILA-KIRWAN, GUADALUPE (MD)
Entity Type:Individual
Prefix:DR
First Name:GUADALUPE
Middle Name:
Last Name:AVILA-KIRWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15045 MCELROY RD
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722-9408
Mailing Address - Country:US
Mailing Address - Phone:530-878-6428
Mailing Address - Fax:
Practice Address - Street 1:3111 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2456
Practice Address - Country:US
Practice Address - Phone:530-885-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G847830Medicaid
CA00G847830Medicaid
CAG58645Medicare UPIN