Provider Demographics
NPI:1508122110
Name:AVILA, MIRLA L (MD)
Entity Type:Individual
Prefix:
First Name:MIRLA
Middle Name:L
Last Name:AVILA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3601 4TH STREET, MS 8321
Mailing Address - Street 2:DEPT. OF NEUROLOGY
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-8321
Mailing Address - Country:US
Mailing Address - Phone:806-743-2391
Mailing Address - Fax:806-743-5687
Practice Address - Street 1:3601 4TH STREET, MS 8321
Practice Address - Street 2:DEPT. OF NEUROLOGY
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430
Practice Address - Country:US
Practice Address - Phone:806-743-2391
Practice Address - Fax:806-743-5687
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2024-03-20
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Provider Licenses
StateLicense IDTaxonomies
TXQ97822084N0402X, 2084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology