MEDICARE: EMIL AVANES, M.D., A PROFESSIONAL CORPORATION

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	207R00000X	Internal Medicine Physician	A110814	CA

General Provider Information

NPI Number	:	1245505833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMIL AVANES, M.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3217 N VERDUGO RD STE 1
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1676
Country	:	US
Telephone Number	:	818-369-7470
Fax Number	:	818-369-7471

Provider Business Practice Location Address
First Line	:	3217 N VERDUGO RD STE 1
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1676
Country	:	US
Telephone Number	:	818-369-7470
Fax Number	:	818-369-7471

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	EMIL AVANES
Credential	:	MD
Telephone Number	:	818-369-7470

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	10/31/2019

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