Healthcare Provider Details

I. General information

NPI: 1629467915
Provider Name (Legal Business Name): CELIA AVILA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 PIONEER BLVD SUITE 110
HAWAIIAN GARDENS CA
90716-2603
US

IV. Provider business mailing address

PO BOX 951
BALDWIN PARK CA
91706-0951
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-3644
  • Fax:
Mailing address:
  • Phone: 909-620-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT115993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: