Provider Demographics
NPI:1184760167
Name:AVELAR, ELIZABETH ROSE (PPS)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ROSE
Last Name:AVELAR
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:ROSE
Other - Last Name:AVELAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPS
Mailing Address - Street 1:2371 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3624
Mailing Address - Country:US
Mailing Address - Phone:760-457-5597
Mailing Address - Fax:
Practice Address - Street 1:450 W 6TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2973
Practice Address - Country:US
Practice Address - Phone:928-344-6856
Practice Address - Fax:928-344-6930
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool