Provider Demographics
NPI:1356663322
Name:AVILA, JOSEFINA MELARA (SPEECH ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:MELARA
Last Name:AVILA
Suffix:
Gender:F
Credentials:SPEECH ASSISTANT
Other - Prefix:
Other - First Name:JOSEFINA
Other - Middle Name:
Other - Last Name:MELARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPEECH ASSISTANT
Mailing Address - Street 1:15380 W YOUNG ST APT 3027
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7459
Mailing Address - Country:US
Mailing Address - Phone:623-202-2205
Mailing Address - Fax:
Practice Address - Street 1:15802 N PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7466
Practice Address - Country:US
Practice Address - Phone:623-876-7853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA65242355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant