Healthcare Provider Details

I. General information

NPI: 1578739702
Provider Name (Legal Business Name): LYNDON DAYAO AVELINO BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 W LAMAR RD
GLENDALE AZ
85303-7617
US

IV. Provider business mailing address

7230 W LAMAR RD
GLENDALE AZ
85303-7617
US

V. Phone/Fax

Practice location:
  • Phone: 623-242-9661
  • Fax: 623-242-9661
Mailing address:
  • Phone: 623-242-9661
  • Fax: 623-242-9661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN096243
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN096243
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberRN096243
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: