Provider Demographics
NPI:1669827176
Name:AVILA, ALEXIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:AVILA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 E KATELLA AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5945
Mailing Address - Country:US
Mailing Address - Phone:714-460-2777
Mailing Address - Fax:714-460-2777
Practice Address - Street 1:2400 E KATELLA AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5945
Practice Address - Country:US
Practice Address - Phone:714-460-2777
Practice Address - Fax:714-460-2777
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical