Provider Demographics
NPI:1609483478
Name:AVILAN, IRIANA ELEN
Entity Type:Individual
Prefix:
First Name:IRIANA
Middle Name:ELEN
Last Name:AVILAN
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 1:423 CORPORAL EVANS RD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93944-3403
Mailing Address - Country:US
Mailing Address - Phone:831-242-5612
Mailing Address - Fax:
Practice Address - Street 1:423 CORPORAL EVANS RD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944-3403
Practice Address - Country:US
Practice Address - Phone:831-242-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist