Provider Demographics
NPI:1407063175
Name:RAFAEL A. AVILA M.D. P.A.
Entity Type:Organization
Organization Name:RAFAEL A. AVILA M.D. P.A.
Other - Org Name:AVILA PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AZALIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-519-1332
Mailing Address - Street 1:1022 E GRIFFIN PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2400
Mailing Address - Country:US
Mailing Address - Phone:956-519-1332
Mailing Address - Fax:956-519-3515
Practice Address - Street 1:1022 E GRIFFIN PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2400
Practice Address - Country:US
Practice Address - Phone:956-519-1332
Practice Address - Fax:956-519-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5785261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089960102Medicaid
TX00918DMedicare ID - Type Unspecified
TX1407063175Medicare PIN
TXG50099Medicare UPIN