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NPI Code Detail

MEDICARE: EDEN SARAY AVILA PA-C

MEDICARE: EDEN SARAY AVILA 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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1922683515
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDEN SARAY AVILA PA-C
Provider Business Mailing Address
First Line : PO BOX 39614
Second Line :
City : LOS ANGELES
State : CA
Zip : 90039-0614
Country : US
Telephone Number : 619-614-4933
Fax Number :
Provider Business Practice Location Address
First Line : 5885 BROCKTON AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92506-1863
Country : US
Telephone Number : 619-614-4933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2021
Last Update Date : 06/16/2026

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Directions to “ EDEN SARAY AVILA PA-C” Practice Location

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