Healthcare Provider Details

I. General information

NPI: 1275860504
Provider Name (Legal Business Name): ANA G AVILES ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ADELINE ST STE 120
BERKELEY CA
94703-2579
US

IV. Provider business mailing address

2274 PARK PL
RIO VISTA CA
94571-5300
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-1112
  • Fax: 510-848-4445
Mailing address:
  • Phone: 510-355-7382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: