MEDICARE: MR. MICHAEL AVILA-CABRAL PA-C

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	363AM0700X	Medical Physician Assistant	PA20684	CA
2	363AM0700X	Medical Physician Assistant	PA2506	NV

General Provider Information

NPI Number	:	1689903155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL AVILA-CABRAL PA-C

Provider Business Mailing Address
First Line	:	2100 POWELL ST
Second Line	:	SUITE 900
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-1826
Country	:	US
Telephone Number	:	510-350-2698
Fax Number	:	510-879-9084

Provider Business Practice Location Address
First Line	:	1550 W CRAIG RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0327
Country	:	US
Telephone Number	:	702-777-3615
Fax Number	:

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

Provider Enumeration Date	:	12/13/2009
Last Update Date	:	06/06/2024

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