Provider Demographics
NPI:1912200684
Name:BRUGES AVILA, LINA MARGARITA (MA, SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINA
Middle Name:MARGARITA
Last Name:BRUGES AVILA
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 CLIFFDALE RD STE 1111
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0034
Mailing Address - Country:US
Mailing Address - Phone:910-229-3951
Mailing Address - Fax:
Practice Address - Street 1:5945 CLIFFDALE RD STE 1111
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0034
Practice Address - Country:US
Practice Address - Phone:910-229-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist