MEDICARE: BLANCA GLORIA 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	251E00000X	Home Health Agency	3718441432	CA

General Provider Information

NPI Number	:	1861056962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANCA GLORIA AVILA

Provider Business Mailing Address
First Line	:	930 PAYNE AVE
Second Line	:
City	:	GUSTINE
State	:	CA
Zip	:	95322-1819
Country	:	US
Telephone Number	:	408-655-1391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1522 HILLSDALE AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-1037
Country	:	US
Telephone Number	:	408-655-1391
Fax Number	:

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

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	04/24/2019

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Directions to “ BLANCA GLORIA AVILA ” Practice Location

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