Healthcare Provider Details

I. General information

NPI: 1013811041
Provider Name (Legal Business Name): MARICELLA AVILA L. AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 SPRINGFIELD RD
GLEN ALLEN VA
23060-4119
US

IV. Provider business mailing address

3900 SPRINGFIELD RD
GLEN ALLEN VA
23060-4119
US

V. Phone/Fax

Practice location:
  • Phone: 804-774-7118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121001302
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: