Provider Demographics
NPI:1790109205
Name:AVILA, VALERIE
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:
Last Name: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 1:12035 PAUL KLEE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0217
Mailing Address - Country:US
Mailing Address - Phone:915-241-5115
Mailing Address - Fax:915-307-6829
Practice Address - Street 1:12035 PAUL KLEE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0217
Practice Address - Country:US
Practice Address - Phone:915-241-5115
Practice Address - Fax:915-307-6829
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX745312171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator