Provider Demographics
NPI:1851809719
Name:AVILES, IGNACIO
Entity Type:Individual
Prefix:
First Name:IGNACIO
Middle Name:
Last Name:AVILES
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 1:560 IMPERIAL HWY APT G
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27777 INKSTER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5310
Practice Address - Country:US
Practice Address - Phone:248-436-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2023-09-26
Deactivation Date:2022-08-25
Deactivation Code:
Reactivation Date:2022-09-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician