Healthcare Provider Details

I. General information

NPI: 1770356131
Provider Name (Legal Business Name): AARON AVILA LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S WASHINGTON ST STE LL500
NAPERVILLE IL
60540-5324
US

IV. Provider business mailing address

3823 OAK PARK AVE
BERWYN IL
60402-3959
US

V. Phone/Fax

Practice location:
  • Phone: 708-752-3332
  • Fax:
Mailing address:
  • Phone: 708-752-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.001628
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: