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General NPI Number Information
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NPI Number | 1467231829
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Entity Type | Individual
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Provider Name | MERCEDES AVILA FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1223 16TH ST STE 3100
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City | SANTA MONICA
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State | CA
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Zip | 90404-1275
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Country | US
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Telephone | 310-582-6240
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD SUITE 400
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City | LOS ANGELES
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State | CA
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Zip | 90095-5631
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Country | US
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Telephone | 310-301-8707
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95026457
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95026457
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License Number State | CA
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