Provider Demographics
NPI:1265623615
Name:AVILA-GNAU, VIVIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:VIVIANA
Middle Name:
Last Name:AVILA-GNAU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26347 DELGADO AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4184
Mailing Address - Country:US
Mailing Address - Phone:909-747-7273
Mailing Address - Fax:909-522-4152
Practice Address - Street 1:26347 DELGADO AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4184
Practice Address - Country:US
Practice Address - Phone:909-747-7273
Practice Address - Fax:909-522-4152
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice