Healthcare Provider Details

I. General information

NPI: 1972133247
Provider Name (Legal Business Name): PAULINE AVILA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FANNIN ST
HOUSTON TX
77030-2703
US

IV. Provider business mailing address

6550 FANNIN ST STE 1001
HOUSTON TX
77030-2740
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-3020
  • Fax:
Mailing address:
  • Phone: 713-799-9997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number848064
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1031960
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: