MEDICARE: EUGENIA G AVIDANO

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	106H00000X	Marriage & Family Therapist	49794	CA

General Provider Information

NPI Number	:	1902115108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENIA G AVIDANO

Provider Business Mailing Address
First Line	:	4459 DALE AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-6206
Country	:	US
Telephone Number	:	619-328-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4459 DALE AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-6206
Country	:	US
Telephone Number	:	619-328-7000
Fax Number	:

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

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	08/29/2025

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