Provider Demographics
NPI:1336565399
Name:AVILA, RICHARD (RN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:AVILA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2422
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95063-2422
Mailing Address - Country:US
Mailing Address - Phone:213-787-6195
Mailing Address - Fax:
Practice Address - Street 1:650 DAY VALLEY RD
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-9323
Practice Address - Country:US
Practice Address - Phone:213-787-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA772267163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse