Provider Demographics
NPI:1851594907
Name:AVILA, PATRIA ELENA (BA)
Entity Type:Individual
Prefix:MRS
First Name:PATRIA
Middle Name:ELENA
Last Name:AVILA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:954-567-7141
Mailing Address - Fax:954-703-2029
Practice Address - Street 1:830 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-567-7141
Practice Address - Fax:954-703-2029
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator