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General NPI Number Information
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NPI Number | 1235822057
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Entity Type | Individual
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Provider Name | REBECCA AVILA
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Gender | Female
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 05/29/2023
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Provider Practice Location Address
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Address Line | 50 W EDMONSTON DR STE 404
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City | ROCKVILLE
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State | MD
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Zip | 20852-1274
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Country | US
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Telephone | 301-762-7723
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Fax |
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Provider Business Mailing Address
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Address Line | 6020 OFFSHORE GRN
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City | COLUMBIA
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State | MD
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Zip | 21045-3822
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Country | US
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Telephone | 915-253-4703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AC005412
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License Number State | MD
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