Healthcare Provider Details

I. General information

NPI: 1922862234
Provider Name (Legal Business Name): ASHLEY AVALOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17802 SKY PARK CIR # 108
IRVINE CA
92614-6403
US

IV. Provider business mailing address

11150 W OLYMPIC BLVD STE 1160
LOS ANGELES CA
90064-1826
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-1111
  • Fax:
Mailing address:
  • Phone: 424-559-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: