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General NPI Number Information
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NPI Number | 1336251594
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Entity Type | Individual
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Provider Name | MARCIA ILENE AVILA M.S. M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 80 EUREKA SQ STE 151
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City | PACIFICA
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State | CA
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Zip | 94044-2603
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Country | US
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Telephone | 650-400-5293
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Fax | 650-355-8745
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Provider Business Mailing Address
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Address Line | 80 EUREKA SQ STE 151
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City | PACIFICA
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State | CA
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Zip | 94044-2603
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Country | US
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Telephone | 650-400-5293
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Fax | 650-355-8745
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC37750
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License Number State | CA
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