Provider Demographics
NPI:1346452802
Name:AVILA, SHIRLEY
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
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 1:295 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4269
Mailing Address - Country:US
Mailing Address - Phone:909-875-8369
Mailing Address - Fax:
Practice Address - Street 1:802 W COLTON AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2905
Practice Address - Country:US
Practice Address - Phone:909-335-2989
Practice Address - Fax:909-335-1701
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator