MEDICARE: NAOMI MARIEL AVILES

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1528606399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI MARIEL AVILES

Provider Business Mailing Address
First Line	:	3425 COFFEE RD STE C2
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-1582
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 HIGHTOWER TRL STE B120
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-6205
Country	:	US
Telephone Number	:	866-750-5554
Fax Number	:

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

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	12/12/2019

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Directions to “ NAOMI MARIEL AVILES ” Practice Location

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