Provider Demographics
NPI:1760061907
Name:GILBERT AVILA, EMY MAYELY
Entity Type:Individual
Prefix:
First Name:EMY
Middle Name:MAYELY
Last Name:GILBERT AVILA
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 1:30931 114TH LN SE SPC 13
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3303
Mailing Address - Country:US
Mailing Address - Phone:253-670-8352
Mailing Address - Fax:
Practice Address - Street 1:30931 114TH LN SE SPC 13
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-3303
Practice Address - Country:US
Practice Address - Phone:253-670-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602558144171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter