Healthcare Provider Details

I. General information

NPI: 1053954818
Provider Name (Legal Business Name): JOAN AVILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73271 FRED WARING DR
PALM DESERT CA
92260-2883
US

IV. Provider business mailing address

21600 OXNARD ST
WOODLAND HILLS CA
91367-4976
US

V. Phone/Fax

Practice location:
  • Phone: 760-469-9650
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberB9473681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: