Healthcare Provider Details

I. General information

NPI: 1013035591
Provider Name (Legal Business Name): YOLANDA AVILA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 W 16TH ST
CHICAGO IL
60608
US

IV. Provider business mailing address

1421 W 16TH ST
CHICAGO IL
60608
US

V. Phone/Fax

Practice location:
  • Phone: 312-491-1676
  • Fax: 312-491-8431
Mailing address:
  • Phone: 312-491-1676
  • Fax: 312-491-8431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: