Provider Demographics
NPI:1851535702
Name:AVILA, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:AVILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 W SHAW AVE
Mailing Address - Street 2:101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3234
Mailing Address - Country:US
Mailing Address - Phone:559-275-1784
Mailing Address - Fax:559-275-1768
Practice Address - Street 1:3435 W SHAW AVE
Practice Address - Street 2:101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3234
Practice Address - Country:US
Practice Address - Phone:559-275-1784
Practice Address - Fax:559-275-1768
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)