Provider Demographics
NPI:1831297514
Name:AVILA EDWARDS, KIMBERLY CRUZITA (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:CRUZITA
Last Name:AVILA EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:6835 AUSTIN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3166
Practice Address - Country:US
Practice Address - Phone:512-346-6611
Practice Address - Fax:512-465-1633
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152555201Medicaid
TX152555205Medicaid
TX152555202Medicaid
TX152555206Medicaid
TX152555206Medicaid
TXTXB146738Medicare PIN
TXTXB146735Medicare PIN
TX8568B7Medicare PIN
TX8L10205Medicare PIN