Provider Demographics
NPI:1457475014
Name:AVALOS, JAMES (FNP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:AVALOS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MARCELA DR STE C
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-5769
Mailing Address - Country:US
Mailing Address - Phone:707-459-6115
Mailing Address - Fax:
Practice Address - Street 1:3 MARCELA DR STE C
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-5769
Practice Address - Country:US
Practice Address - Phone:707-459-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CA95016314363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical