Provider Demographics
NPI:1245505833
Name:EMIL AVANES, M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EMIL AVANES, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-369-7470
Mailing Address - Street 1:3217 N VERDUGO RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1676
Mailing Address - Country:US
Mailing Address - Phone:818-369-7470
Mailing Address - Fax:818-369-7471
Practice Address - Street 1:3217 N VERDUGO RD STE 1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1676
Practice Address - Country:US
Practice Address - Phone:818-369-7470
Practice Address - Fax:818-369-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty