Provider Demographics
NPI:1821646860
Name:AVILA, TONI MAXINE
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:MAXINE
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 1:2606 BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-3255
Mailing Address - Country:US
Mailing Address - Phone:209-662-0733
Mailing Address - Fax:
Practice Address - Street 1:2606N BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-3255
Practice Address - Country:US
Practice Address - Phone:209-662-0733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider