Provider Demographics
NPI:1497819429
Name:AVERY, ERNESTINE
Entity Type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:
Last Name:AVERY
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 1:12440 FIRSTONE BLVD #3025
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:562-929-6688
Mailing Address - Fax:562-929-9074
Practice Address - Street 1:12440 FIRESTONE BLVD STE 3020
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-9328
Practice Address - Country:US
Practice Address - Phone:562-864-7821
Practice Address - Fax:562-864-7864
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist