Provider Demographics
NPI:1538684055
Name:AVILA, IVAN JAVIER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:JAVIER
Last Name:AVILA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:7430 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3504
Mailing Address - Country:US
Mailing Address - Phone:915-875-1801
Mailing Address - Fax:915-875-1516
Practice Address - Street 1:7430 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3504
Practice Address - Country:US
Practice Address - Phone:915-875-1801
Practice Address - Fax:915-875-1516
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2019-02-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant