Provider Demographics
NPI:1720799307
Name:AVILES, KARINA DAWN ELMIDO (NP)
Entity Type:Individual
Prefix:
First Name:KARINA DAWN
Middle Name:ELMIDO
Last Name:AVILES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 N BRANTFORD ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-1611
Mailing Address - Country:US
Mailing Address - Phone:714-270-0605
Mailing Address - Fax:
Practice Address - Street 1:636 BROADWAY
Practice Address - Street 2:3F SUITE 25
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101
Practice Address - Country:US
Practice Address - Phone:888-538-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95023325363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner