Healthcare Provider Details

I. General information

NPI: 1255734232
Provider Name (Legal Business Name): SANDRA AVILES M.A. CLINICAL COUNSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 E COOLEY DR STE 100
COLTON CA
92324-3921
US

IV. Provider business mailing address

25910 ACERO STE 160
MISSION VIEJO CA
92691-2777
US

V. Phone/Fax

Practice location:
  • Phone: 877-527-7227
  • Fax:
Mailing address:
  • Phone: 877-527-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT112401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: