Healthcare Provider Details

I. General information

NPI: 1508200700
Provider Name (Legal Business Name): CRISTINA VANESSA AVILES LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 PAINTER AVENUE, SUITE C
WHITTIER CA
90602
US

IV. Provider business mailing address

41 E. FOOTHILL BLVD. SUITE 102
ARCADIA CA
91006
US

V. Phone/Fax

Practice location:
  • Phone: 562-203-0177
  • Fax: 626-737-6034
Mailing address:
  • Phone: 626-701-4249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number99960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: