Provider Demographics
NPI:1124267950
Name:AMADOR AVILA, MARIBEL
Entity type:Individual
Prefix:MISS
First Name:MARIBEL
Middle Name:
Last Name:AMADOR AVILA
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 1:3605 VISTA WAY STE 258
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4565
Mailing Address - Country:US
Mailing Address - Phone:760-758-1480
Mailing Address - Fax:760-435-9472
Practice Address - Street 1:3605 VISTA WAY STE 258
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4565
Practice Address - Country:US
Practice Address - Phone:760-758-1480
Practice Address - Fax:760-435-9472
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator