Provider Demographics
NPI:1972046878
Name:AVALOS ROSALES, ASTRID NATALIA
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:NATALIA
Last Name:AVALOS ROSALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6414 FLUSHING AVE APT 3R
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2843
Mailing Address - Country:US
Mailing Address - Phone:347-965-7905
Mailing Address - Fax:
Practice Address - Street 1:6414 FLUSHING AVE APT 3R
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2843
Practice Address - Country:US
Practice Address - Phone:347-965-7905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-24
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist