Healthcare Provider Details

I. General information

NPI: 1417821398
Provider Name (Legal Business Name): ALLYSON ANGELINA AVILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W PUEBLO ST STE 14
SANTA BARBARA CA
93105-3989
US

IV. Provider business mailing address

121 W PUEBLO ST STE 14
SANTA BARBARA CA
93105-3989
US

V. Phone/Fax

Practice location:
  • Phone: 805-637-9454
  • Fax:
Mailing address:
  • Phone: 805-637-9454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: