MEDICARE: JOSUE DE AVILA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1003159633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSUE DE AVILA

Provider Business Mailing Address
First Line	:	9015 MURRAY AVE
Second Line	:	SUITE 100
City	:	GILROY
State	:	CA
Zip	:	95020-3617
Country	:	US
Telephone Number	:	408-846-4733
Fax Number	:

Provider Business Practice Location Address
First Line	:	9015 MURRAY AVE
Second Line	:	SUITE 100
City	:	GILROY
State	:	CA
Zip	:	95020-3617
Country	:	US
Telephone Number	:	408-846-4733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2013
Last Update Date	:	04/02/2013

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Directions to “ JOSUE DE AVILA ” Practice Location

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