Provider Demographics
NPI:1326793191
Name:AVILA, MAXIMO CANDIDO (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MAXIMO
Middle Name:CANDIDO
Last Name:AVILA
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NE 149TH ST APT 108A
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-2279
Mailing Address - Country:US
Mailing Address - Phone:786-308-3444
Mailing Address - Fax:
Practice Address - Street 1:11760 SW 40TH ST STE 511
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8100
Practice Address - Country:US
Practice Address - Phone:786-308-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11017068363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health