Provider Demographics
NPI:1841956513
Name:AVILA, CARMEN (MT108134)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:
Last Name:AVILA
Suffix:
Gender:F
Credentials:MT108134
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WESTWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6168
Mailing Address - Country:US
Mailing Address - Phone:956-739-9456
Mailing Address - Fax:
Practice Address - Street 1:1719 N 23RD ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6119
Practice Address - Country:US
Practice Address - Phone:956-739-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT108134225700000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist