Healthcare Provider Details

I. General information

NPI: 1285390278
Provider Name (Legal Business Name): LETICIA AVALOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2021
Last Update Date: 11/13/2021
Certification Date: 11/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 E TULARE AVE
TULARE CA
93274-3155
US

IV. Provider business mailing address

832 E LYNDALE DR
TULARE CA
93274-2932
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-5839
  • Fax: 559-688-2470
Mailing address:
  • Phone: 559-310-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: