Provider Demographics
NPI:1912267105
Name:AVILA, MARIA NOELA (RN ,IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:NOELA
Last Name:AVILA
Suffix:
Gender:F
Credentials:RN ,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1701 JACAMAN RD
Mailing Address - Street 2:SUITE 8B
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6210
Mailing Address - Country:US
Mailing Address - Phone:956-717-6053
Mailing Address - Fax:
Practice Address - Street 1:1701 JACAMAN RD
Practice Address - Street 2:SUITE 8B
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6210
Practice Address - Country:US
Practice Address - Phone:956-717-6053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11119244163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant