Provider Demographics
NPI:1013423813
Name:VISTRO, AUDREY ABELLERA
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:ABELLERA
Last Name:VISTRO
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 1:2184 CORTE ANACAPA
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4468
Mailing Address - Country:US
Mailing Address - Phone:619-829-8748
Mailing Address - Fax:619-816-5477
Practice Address - Street 1:2184 CORTE ANACAPA
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4468
Practice Address - Country:US
Practice Address - Phone:619-829-8748
Practice Address - Fax:619-816-5477
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-17
Last Update Date:2017-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician