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General NPI Number Information
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NPI Number | 1386586204
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Entity Type | Individual
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Provider Name | LIZETH AVILA
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Gender |
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | AV CARLOS G CALLES 3607 BUROCRATA
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City | SAN LUIS RIO COLORADO
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State | SONORA
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Zip | 83450
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Country | MX
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 3554 SUNSET LN UNIT 32
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City | SAN YSIDRO
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State | CA
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Zip | 92173-4506
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Country | US
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Telephone | 619-831-0437
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Fax | 619-785-3404
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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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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