Healthcare Provider Details

I. General information

NPI: 1013823657
Provider Name (Legal Business Name): AVIELA CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 S PROSPECT AVE STE A
TUSTIN CA
92780-1523
US

IV. Provider business mailing address

27151 PASEO PEREGRINO
SAN JUAN CAPISTRANO CA
92675-5041
US

V. Phone/Fax

Practice location:
  • Phone: 415-646-6223
  • Fax:
Mailing address:
  • Phone: 949-496-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: