Healthcare Provider Details

I. General information

NPI: 1578140919
Provider Name (Legal Business Name): DAVID AVILA MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VALPREDA ROAD
SAN MARCOS CA
92069
US

IV. Provider business mailing address

3260 KERNER BLVD
SAN RAFAEL CA
94901-4840
US

V. Phone/Fax

Practice location:
  • Phone: 760-736-6767
  • Fax:
Mailing address:
  • Phone: 415-448-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA193340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: