Provider Demographics
NPI:1710715636
Name:AVALOS, ERICA (RN, BSN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:AVALOS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37412 SANTOS GOMEZ DR
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-8963
Mailing Address - Country:US
Mailing Address - Phone:956-266-2729
Mailing Address - Fax:
Practice Address - Street 1:37412 SANTOS GOMEZ DR
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-8963
Practice Address - Country:US
Practice Address - Phone:956-266-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680793163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse