Healthcare Provider Details

I. General information

NPI: 1063361392
Provider Name (Legal Business Name): LIZBETH AVALOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 TECHNOLOGY DR STE 139
IRVINE CA
92618-2324
US

IV. Provider business mailing address

25992 DUNDEE DR
LAKE FOREST CA
92630-8019
US

V. Phone/Fax

Practice location:
  • Phone: 949-385-1656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: