Healthcare Provider Details

I. General information

NPI: 1205962172
Provider Name (Legal Business Name): CARMELINA NANCY AVILA R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 COUNTY FARM RD SUITE 6
RIVERSIDE CA
92503-3542
US

IV. Provider business mailing address

3893 ELMWOOD CT
RIVERSIDE CA
92506-1110
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-7380
  • Fax: 951-358-6311
Mailing address:
  • Phone: 951-274-9819
  • Fax: 909-890-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number474596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: