MEDICARE: GUADALUPE P AVILA GUADALUPE 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	1041C0700X	Clinical Social Worker	055836	FL
2	252Y00000X	Early Intervention Provider Agency	055836-1	NY
3	1041C0700X	Clinical Social Worker	055836	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34200	OTHER	NY	FLUSHING HOSPITAL
2	46300	OTHER	NY	PERSONAL TOUCH

General Provider Information

NPI Number	:	1891949160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUADALUPE P AVILA GUADALUPE AVILA

Provider Business Mailing Address
First Line	:	3225 90TH ST APT 408
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11369-2306
Country	:	US
Telephone Number	:	917-907-4737
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 90TH ST
Second Line	:	APT 408
City	:	EAST ELMHURST
State	:	NY
Zip	:	11369-2356
Country	:	US
Telephone Number	:	917-907-4737
Fax Number	:

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

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	03/30/2026

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