Provider Demographics
NPI:1356018105
Name:AVILA, GRISELDA
Entity Type:Individual
Prefix:
First Name:GRISELDA
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 1:633 W 5TH ST FL 26
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90071-2053
Mailing Address - Country:US
Mailing Address - Phone:818-415-7449
Mailing Address - Fax:888-307-1725
Practice Address - Street 1:633 W 5TH ST FL 26
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-2053
Practice Address - Country:US
Practice Address - Phone:818-415-7449
Practice Address - Fax:888-307-1725
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician