Healthcare Provider Details

I. General information

NPI: 1902477532
Provider Name (Legal Business Name): ANTHONY AVILA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE FL ACCW4
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE FL ACCW4
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6000
  • Fax: 305-585-6858
Mailing address:
  • Phone: 305-585-6000
  • Fax: 305-585-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11024155
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: