Provider Demographics
NPI:1730675521
Name:KAYBELLA12 LLC
Entity Type:Organization
Organization Name:KAYBELLA12 LLC
Other - Org Name:AVILA PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:CESAR
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-464-4497
Mailing Address - Street 1:308 N SALINAS BLVD
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-2930
Mailing Address - Country:US
Mailing Address - Phone:956-464-4497
Mailing Address - Fax:956-464-7713
Practice Address - Street 1:308 N SALINAS BLVD
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2930
Practice Address - Country:US
Practice Address - Phone:956-464-4497
Practice Address - Fax:956-464-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty