MEDICARE: MARIE ELIZABETH 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	104100000X	Social Worker	LMSW-20800	AZ

General Provider Information

NPI Number	:	1104091826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE ELIZABETH AVILA

Provider Business Mailing Address
First Line	:	4760 E BASELINE RD APT 2085
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4690
Country	:	US
Telephone Number	:	602-599-5575
Fax Number	:

Provider Business Practice Location Address
First Line	:	4760 E BASELINE RD APT 2085
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4690
Country	:	US
Telephone Number	:	480-232-2766
Fax Number	:

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

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	11/07/2023

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Directions to “ MARIE ELIZABETH AVILA ” Practice Location

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