Healthcare Provider Details

I. General information

NPI: 1962898445
Provider Name (Legal Business Name): KATHERINA AVILA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2663 S LANCASTER RD
DALLAS TX
75216-3112
US

IV. Provider business mailing address

PO BOX 746079
ATLANTA GA
30374-6079
US

V. Phone/Fax

Practice location:
  • Phone: 214-296-4341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRS2015-0388
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS2725
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: