Provider Demographics
NPI:1457599292
Name:AVILA, JONATHAN CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CHRISTOPHER
Last Name:AVILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-3111
Mailing Address - Country:US
Mailing Address - Phone:818-833-9789
Mailing Address - Fax:818-833-9790
Practice Address - Street 1:2501 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3111
Practice Address - Country:US
Practice Address - Phone:818-833-9789
Practice Address - Fax:818-833-9790
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)