Healthcare Provider Details

I. General information

NPI: 1700118726
Provider Name (Legal Business Name): HECTOR AVILA MADRIL JR. M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 01/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE SUITE 203
LOS ANGELES CA
90025-5363
US

IV. Provider business mailing address

PO BOX 641112
LOS ANGELES CA
90064-6112
US

V. Phone/Fax

Practice location:
  • Phone: 310-985-4863
  • Fax:
Mailing address:
  • Phone: 310-985-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number84743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: