Healthcare Provider Details

I. General information

NPI: 1760398739
Provider Name (Legal Business Name): SAND EMERSON AVILA MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

30 PHILADELPHIA DR STE B
CHICO CA
95973-4932
US

IV. Provider business mailing address

590 ANTELOPE BLVD STE 20
RED BLUFF CA
96080-2474
US

V. Phone/Fax

Practice location:
  • Phone: 530-526-5419
  • Fax:
Mailing address:
  • Phone: 530-528-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: