Provider Demographics
NPI:1619369915
Name:AVITIA, LUIS (RN)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:AVITIA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7643 PAINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2358
Mailing Address - Country:US
Mailing Address - Phone:562-464-5380
Mailing Address - Fax:562-693-4525
Practice Address - Street 1:7643 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2358
Practice Address - Country:US
Practice Address - Phone:562-464-5380
Practice Address - Fax:562-693-4525
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616227163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management