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General NPI Number Information
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NPI Number | 1174328942
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Entity Type | Organization
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Legal Business Name | AVALIA HEALTH LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 3519 MOUNTAIN VIEW DR
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City | ANCHORAGE
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State | AK
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Zip | 99508-1111
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Country | US
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Telephone | 907-868-1105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 140968
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City | ANCHORAGE
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State | AK
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Zip | 99514-0968
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Country | US
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Telephone | 907-531-0027
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JONATHAN VAN RAVENSWAAY
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Credential | MD
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Telephone | 907-531-0027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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