Healthcare Provider Details

I. General information

NPI: 1538679980
Provider Name (Legal Business Name): SILVANA AVILES PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SILVANA GOOD

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date: 11/06/2022
Reactivation Date: 11/15/2022

III. Provider practice location address

6904 VILLAGE PKWY
DUBLIN CA
94568-2406
US

IV. Provider business mailing address

31344 VIA COLINAS STE 108
WESTLAKE VILLAGE CA
91362-6797
US

V. Phone/Fax

Practice location:
  • Phone: 805-379-3212
  • Fax:
Mailing address:
  • Phone: 805-379-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY33695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: